Functional and Quality of Life Outcomes Following Lateral Arm Flap Reconstruction for Medium-Sized Head and Neck Defects: A Prospective Study.

Abstract

Introduction: Since the 1970s, free tissue transfer has gradually become known around globally as a reliable and sustainable technique in head and neck surgery. Microvascular reconstruction of the head and neck comprises of specialized surgical techniques used to replace lost tissue in the maxillofacial and neck region with tissue from other parts of the body. The Lateral Arm Free Flap (LAFF), one among several free flaps that have been developed, was initially introduced by Song et al. in 1982 and further developed by Cormack and Katsaros in 1984. Compared to other fasciocutaneous flaps, the lateral arm flap is an attractive option as it is a thin flap that is harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery. Lateral arm flap has unique advantages such as being able to deliver adequate thickness, color match of skin, easy to harvest, and posing minor complications at the donor site, but it is still a seldom used option in head and neck reconstruction. The purpose of this study was to provide a comprehensive summary of our two years of experience using the LAFF in head and neck reconstruction and to explore the possibility of expanding its application even further.

Aim and objectives: This study aimed to assess the reliability of Lateral Arm Free Flap in head and neck reconstruction after successful tumor ablation. Objectives included evaluating the functional outcomes of the flap donor site and assessing recipient site function using the University of Washington Quality of Life questionnaire v4 (UW-QOL v4), specifically focusing on speech and swallowing abilities.

Materials and method: This clinical prospective study involves 24 patients who underwent microvascular reconstruction of head and neck defects from 2022 to 2024 following head and neck cancer surgery. Data collected following successful reconstruction includes patient demographics, details of defect to be reconstructed, various flap characteristics, recipient site as well as donor site complications, and patient-reported outcomes using Quick DASH and UW-QOL v4 questionnaires. Follow-up range is from the 5th day postoperatively and followed through every three months for a year, with questionnaires completed by patients or attenders to minimize bias.

Results: Our study involved 24 patients treated for head and neck cancer and reconstructed with LAFF. In our series of reconstruction, we had a flap success rate of (95.8%). Over a period of time, disability ratings declined dramatically and there were no substantial donor site problems. Donor arm shoulder function, ability to perform exercise, appearance, and pain all showed improvements in quality of life questioner. Recipient site problems such as adequate saliva production, taste, ability to hold bolus adequately, speaking certain words, and anxiety challenges persisted, but they gradually improved during the first year following surgery.

Conclusion: The LAFF demonstrated exceptional adaptability and multifunctional potential in providing favorable results for head and neck reconstruction. It provided a favorable skin color match and ample fat volume, which are important for achieving optimal aesthetic results. It is crucial to recognize that this flap's shorter vascular pedicle and narrow artery diameter are its drawbacks. However, this flap is effective in reconstruction of medium-sized head and neck defects; its advantages include reliable vascular architecture and minimal donor site morbidity. Overall, the Lateral Arm Free Flap is a reliable alternative option as compared to other fasciocutaneous flaps in head and neck microvascular reconstruction.