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Large defects of the hand usually require reconstruction with flap resurfacing to provide durable coverage and preserve function. Pedicled flaps are preferred when there are no vessels available or they are of questionable quality for anastomosis. Such clinical settings may be due to the primary pathology, or when the vessels are preserved for secondary reconstruction. We introduce the contralateral pedicled lateral arm flap as a viable alternative. From 1988 to 2006, we treated 22 consecutive patients aged between 6 and 70 (18 males and 4 females). The indications for flap reconstruction included hand defects resulting from trauma (n = 16), infection (n = 3), burn (n = 2), and complication of free flap (n = 1). The flap was designed with extension into the forearm and raised based on the posterior radial collateral artery. All patients underwent intensive postoperative mobilization. The flap was divided 3 weeks later after a week of ischemic preconditioning. All the flaps survived. There was no wound infection. The flap size ranged from 18 cm 2 to 127.5 cm 2 . Eighteen reconstructions were fasciocutaneous and 4 were osteofasciocutaneous. Three patients underwent subsequent toe-digit transfer. All patients achieved activities of daily living independently by the third postoperative day. There was no significant shoulder and elbow joints stiffness. The contralateral pedicled lateral arm flap is a reliable option for resurfacing large defect of the hand where pedicled flap is indicated. There is minimal morbidity associated.

The axillary arch is a vestigial muscle in the axilla, which originates from the latissimus dorsi and inserts into the pectoralis major tendon. The aim of this article is to describe a fan-shaped variant of the axillary arch and its clinical implications. We present a patient who underwent an axillary node dissection during which, a fan-shaped axillopectoral muscle measuring 8 cm by 6 cm was encountered. It was disinserted to provide exposure of the axilla.