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The distal lateral arm flap for resurfacing of extensive defects of the digits

The distal lateral arm flap (DLAF) was used to reconstruct six extensive defects of the digits: 2 degloving injuries of the thumb and 4 major skin losses of the fingers. Two adjacent fingers were involved in 1 patient. Flap size ranged from 3 × 7 cm to 9 × 14 cm. Four flaps were reinnervated using the posterior cutaneous nerve of the forearm. All flaps survived, though 1 showed marginal necrosis. Average follow‐up was 53.4 months. Thumb opposition scored 5 according to Kapandji; finger ROM averaged 50.75%; pinch strength 72.5%. Protective sensation with touch localization was restored. Patient satisfaction for resurfaced digits averaged 8.9 on a 10‐points visual analogic scale. All donor sites resulted in a painless scar with good patient satisfaction. The DLAF offers a thin, pliable skin ideal for digit reconstruction, with low rate of donor site morbidity and can be considered when toe‐to‐hand flap transfer is not advisable or refused by the patient. © 2007 Wiley‐Liss, Inc. Microsurgery, 2007.