The versatility of the islanded posterior arm flap for regional reconstruction around the axilla

SummaryIntroductionDefects in the region of the axilla pose a difficult reconstructive problem. Various methods for restoration have been described. We present our experience with the islanded posterior arm flap for regional reconstruction around the axilla.Patients and methodsBetween 2008 and 2013, all patients receiving a posterior arm flap for regional reconstruction around the axilla were entered in a prospectively maintained database. Patient data, surgical details, complications and the need for revisional procedures were recorded.ResultsIn the study period, 35 posterior arm flaps were used in 24 patients (f:m = 11:13; mean age at surgery: 41,3 ± 18,5 years; 11 bilateral procedures) with defects predominately due to hidradenitis suppurativa (n = 31). The remaining indications included tumor resection (n = 2), burn contracture release or thoracic surgery (n = 1 each). The majority of defects were located at the axilla, but also in the proximal upper arm or the adjacent thoracic wall. Major wound complications such as total or partial flap necrosis were not encountered in our series. Minor complications included partial superficial wound dehiscence (n = 4) and superficial wound infection (n = 1), all of which were managed conservatively. In 4 patients a secondary flap trimming procedure was required.ConclusionIn our hands, the posterior arm flap is an excellent choice for axillary reconstruction due to its constant anatomy, robust vascularity, unrivaled freedom of flap insetting, excellent recipient site matching and favorable donor site morbidity. Besides axillary defects, the posterior arm flap may additionally be employed for defects of the adjacent thoracic wall or the proximal two thirds of the upper arm.