Revisiting the Lateral Arm Free Flap for Oral Defects: A Case Series on Flap Viability and Primary Donor Site Closure.

Abstract Background: The reconstruction of complex oral cavity defects following oncologic resection requires versatile soft tissue flaps. While the Radial Forearm Free Flap (RFFF) is a standard option, it is associated with conspicuous donor site morbidity. This study evaluates the efficacy, functional outcomes, and donor site morbidity of the Lateral Arm Free Flap (LAF) in head and neck reconstruction. Methods: A prospective case series was conducted from June 2022 to June 2024 at the National Cancer Institute (Cairo University) and Assiut University Hospitals. Twelve patients with medium-sized soft-tissue defects (tongue, cheek, floor of the mouth) underwent reconstruction with LAF. Parameters assessed included flap viability, operative time, donor site closure (primary vs. secondary), and postoperative complications. Results: The study included 12 patients (7 females, 5 males) with a mean age of 57.5 years. The majority of defects were in the tongue (75%). The flap success rate was 91.7%, with one total flap loss, and the average flap harvesting time was 47.08 minutes. Primary closure of the donor site was achieved in 83.3% of cases. Complications included hypertrophic scarring (58.3%). Furthermore, 41.7% of patients developed sensory deficits (numbness/hypesthesia) due to division of the posterior cutaneous nerve of the forearm (PCNF), with no patients developing radial nerve injury or wrist weakness. Conclusions: The Lateral Arm Free Flap is a reliable alternative to the RFFF for small-to-medium oral defects. It offers the distinct advantage of primary donor site closure and adequate tissue bulk for glossectomy defects, though variable vessel caliber remains a technical consideration.