INTRODUCTION: Free flap choices are based on logic and instinct. Both technical aspects and surgeons preference make the lateral arm flap an important option for soft-tissue head and neck reconstruction.

METHODS: From 1998 to 2003 (54 months), 97 lateral arm flaps were used in 96 patients for head and neck reconstructions. Their average age was 50.5 years. Seventy-two were male. Flap dimensions ranged from 4 x 2 cm to 15 x 8 cm. They were used for: floor of the mouth and tongue reconstruction – 37 cases; retromolar triangle and internal cheek – 22 cases; hypopharynx – 10 cases; palate – 9 cases; lips – 5 cases; and external facial lining – 14 cases. Neural anastomoses were performed for the lip reconstructions.

RESULTS: All flaps survived except for five (success rate: 94.9%). Severe post-operative clinical problems preceded flap failure and death in two cases. One patient underwent another reconstruction using the flap from the opposite side. All but four donor sites were primarily closed. There were no problems with healing at the donor site. Seventy-three patients were able to start walking by the second day of post-op. All patients were satisfied with being able to hide their scars under their sleeves. Four patients complained about having hair inside their mouth, and two about having bad breath.

CONCLUSION: The lateral arm flap can be considered safe and versatile for most of the soft tissue head and neck microsurgical reconstructions. The possibility of sensory recovery through neural anastomoses and the low donor site morbidity enhances its efficiency.