Management of Posttraumatic Posterior Elbow Defects by Nonmicrosurgical Reconstruction

Abstract

Introduction Reconstruction of posterior defects is challenging due to the quality and uniqueness of the excess skin at the elbow that is durable, thick, pliable, and without much subcutaneous tissue. The goal of reconstruction is to cover the elbow defects with a durable skin cover that will facilitate full passive range of motion. In this era of microsurgery, free tissue transfer is feasible for almost any defect. However, in this article, we discuss various locoregional and pedicled flap options and the protocol followed at our institute to tackle posttraumatic posterior elbow defects. Materials and Methods This is a retrospective analysis of 48 patients with posttraumatic posterior elbow defects admitted from January 2012 to February 2020. Posterior elbow defects were assessed according to the size and location and managed with a nonmicrosurgical reconstruction. Results Of 48 patients, 32 were managed with nonmicrosurgical flaps. Eighteen patients had large defects and 14 had small defects. Reverse lateral forearm flap was the workhorse flap for defect coverage. Of 32 flaps, nine developed complications; however, no patient had total flap necrosis. Conclusion Posterior elbow defects are a difficult problem to tackle. To achieve optimal results, all patients with elbow trauma should be attended and managed by orthopaedic and plastic surgeons in collaboration for optimal results. We believe that most of these defects can be resurfaced by nonmicrosurgical reconstruction with proper planning and execution and their utility cannot be understated.

Free flap reconstruction of elbow soft tissue defects: Lessons learned from 15 years of experience

“…A variety of microvascular techniques exist for providing soft tissue coverage of the joint, and these approaches may vary by surgeon and by patient. The body of literature surrounding the use of local flaps for the coverage of elbow defects is well described (Jensen & Moran, 2008; Kahramangil et al, 2022; Patel & Higgins, 2013; Pawar et al, 2022; Stevanovic & Sharpe, 2013); however, the literature on free tissue transfer to the elbow is relatively limited to small case series and case reports (Chui et al, 2012; Koteswara Rao Rayidi et al, 2019). The purpose of this case series was to further explore the role of microvascular free flap coverage for elbow defects as it applies to both limb salvage and functional joint status in an effort to promote improved patient outcomes.…”