Arch Plast Surg.  2012 Mar;39(2):130-136. 10.5999/aps.2012.39.2.130.

Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

• Chui CH
• Wong CH
• Chew WY
• Low MH
• Tan BK

• KMID: 1921076
• DOI: http://doi.org/10.5999/aps.2012.39.2.130

Abstract

BACKGROUND
Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner.
METHODS
A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study.
RESULTS
We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from 4x9 cm (36 cm2) to 15x30 cm (450 cm2) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was 102degrees (range, 45degrees to 140degrees).
CONCLUSIONS
In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

Keyword

Free tissue flaps; Elbow joint; Reconstructive surgical procedures

MeSH Terms

Elbow
Elbow Joint
Fascia Lata
Fractures, Open
Free Tissue Flaps
Humans
Joints
Muscles
Quadriceps Muscle
Reconstructive Surgical Procedures
Retrospective Studies
Skin
Tendons
Thigh
Transplants