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 FIG. 8-02. The lateral arm sensory cutaneous flap is outlined. The Doppler probe demonstrates the location of the profunda brachii artery. Its terminal branch, the posterior radial collateral artery, is the arterial supply to the flap. Sensation to the flap is through the posterior brachial cutaneous nerve, a cutaneous branch of the radial nerve.
 FIG. 8-03. The bony insertions of the intermuscular septum have been transected and the flap is being elevated from distal to proximal.
 FIG. 8-04. The flap has been elevated. The silastic sheet lies between the neurovascular pedicle (superficial) and the radial nerve (deep).
 FIG. 8-05. The flap is next to the debrided wound and is ready for microvascular anastomosis and insetting. No nerve repair was performed because sensation in this area was not critical.
 FIG. 8-06. Three months postoperative. The patient has returned to construction work and is playing squash twice weekly.
 FIG. 8-07. The well-healed donor site does not limit activity.
CASE 2
A 22-year-old army officer had both hands reconstructed with multiple toe transplants after a blast injury. (From Whitney, T.M., Buncke, H.J., Lineaweaver, W.C., and Alpert, B.S.
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Multiple microvascular transplants: A preliminary report of simultaneous versus sequential reconstruction. Ann. Plast. Surg. 23:396, 1989.
 FIG. 8-08. The web space between the toes in a three-toe transplant to the right hand was expanded with a lateral arm flap (See Case 5, Chapter 28).
 FIG. 8-09. Surface markings of the flap.
 FIG. 8-10. The posterior border of the flap has been elevated subfascially, exposing the cutaneous perforators in the lateral intermuscular septum.
 FIG. 8-11. The flap is isolated at the donor site. A 5 cm neurovascular pedicle has been mobilized.
 FIG. 8-12. Flap next to recipient area, ready for an end-to-side repair to the ulnar vessels. The nerve to the flap was repaired to a branch of the ulnar.
 FIG. 8-13. The patient is now capable of 9 cm of digit spread.
CASE 3
A web space and palmar contracture followed a complex hand injury.
 FIG. 8-14. Range of motion of the thumb is restricted.
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