Abstract
Defects around the elbow region are often irregular with exposed nerves, tendons, bones/joint, and implants. Skin grafts, though possible in some cases, must be avoided, as it requires prolonged splintage and physiotherapy to prevent recurrence and elbow stiffness. Distant flaps require multiple stages, and free flaps are rarely indicated for elbow defects. Muscle flaps are bulky. To overcome these problems, distally based fasciocutaneous flaps from medial and lateral sides of the arm based on posterior ulnar recurrent artery and radial recurrent artery, respectively, were used. Ten patients were studied. Age of the patients ranged from 10 to 40 years. Five were male, and five were female. Radial and ulnar recurrent flaps were used in five patients each. The largest flap size was 18 × 8 cm, and the smallest was 10 × 6 cm. The flaps were islanded in four cases, and in six cases, they were used as pedicled flaps. Skin grafts were used in 90% of the patients because large flaps were required for resurfacing; also, our patients had thinner arms with less girth. All flaps survived well. One island flap had venous congestion and marginal necrosis, which eventually healed. A significant improvement of mobility and elbow movement was noted in all patients. These flaps can be raised even from the previously burnt skin, as the pedicle is located deep. These flaps have the following advantages: The flap is reliable (deeply located consistent vascular pedicle), can cover both the flexor and extensor surface of the elbow joint, avoids prolonged splintage, elbow stiffness, and recurrence, good aesthetic, and has functional results.
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References
Hayashi A, Maruyama Y (1990) Anatomical study of the recurrent flaps of the upper arm. Br J Plast Surg 43:300–306
Cormack GC, Lamberty BGH (1984) Fasciocutaneous vessels in the upper arm: application to the design of fasciocutaneous flaps. Plast Reconstr Surg 74:244–249
Baux S, Mimoun M, Kirsch JM, Zumer L, Berard V (1987) Treatment of elbow contractures in burns. Burns 13:241–244
Karacaoglan N, Uysal A (1996) Use of seven-flap plasty for the treatment of axillary and groin postburn contractures. Burns 22:69–72
Lai CS, Lin SD, Tsai CC, Tsai CW (1995) Running Y-V plasty for burn scar contracture. Burns 21:458–462
Vartak A, Keswani MH (1992) X-plasty for repair of burn contractures. Burns 18:326–328
Hyakusoku H, Fumiiri M (1997) The square flap method. Br J Plast Surg 40:40–46
Hallock GG (1991) Local random fasciocutaneous flaps for repair of the burned elbow. J Burn Care Rehabil 12:26
Van Landuyt K, DeCordier BC, Monstrey SJ et al (1998) The antecubital fasciocutaneous island flap for elbow coverage. Ann Plast Surg 41:252
Lamberty BGH, Cormack GC (1983) The antecubital fasciocutaneous flap. Br J Plast Surg 36:428
El-Khatib HA, Mehboub TA, Ali TA (2002) Use of an adipofascial flap based on the proximal perforators of the ulnar artery to correct contracture of elbow burn scars: An anatomic and clinical approach. Plast Reconstr Surg 109(1):130–136
Mathes SJ, Nahai F (1979) Clinical atlas of muscle and musculocutaneous flaps, 1st edn. Mosby, St. Louis
Ohtsuka H, Imagawa S (1985) Reconstruction of a posterior defect of the elbow joint using an extensor carpi radialis longus myocutaneous flap: case report. Br J Plast Surg 38:238
Burstein FD, Salomon JC, Stahl RS (1989) Elbow joint salvage with the transverse rectus island flap: a new application. Plast Reconstr Surg 84:492
Fisher J (1985) External oblique fasciocutaneous flap for elbow coverage. Plast Reconstr Surg 75:51
Mordick TG, Britton EN, Brantigan C (1996) Pedicled latissimus dorsi transfer for immediate soft tissue coverage and elbow flexion. Plast Reconstr Surg 99:1742–1744
De Lorenzi F, van der Hulst R, Boeckx W (2001) Free flaps in burn reconstruction. Burns 27:603–612
Maruyama Y, Takeuchi S (1986) The radial recurrent fasciocutaneous flap: reverse upper arm flap. Br J Plast Surg 39:458–6
Hayashi A, Maruyama Y, Saze M, Okada E (2004) Ulnar recurrent adipofascial flap for reconstruction of massive defects around the elbow and forearm. Br J Plast Surg 37:632–637
Aslan G, Tuncali D, Cigsar B et al (2006) The propeller flap for postburn elbow contractures. Burns 32:112–115
Prantl L, Schreml S, Schwarze H et al (2008) A safe and simple technique using the distal pedicled reverse upper arm flap to cover large elbow defects. J Plast Reconstr Aesthet Surg 61:546–551
Turegun M, Nisanci M, Duman H et al (2005) Versatility of the reverse lateral arm flap in the treatment of post-burn antecubital contractures. Burns 31:212–216
Lai CS, Lin SD, Chou CK, Tsai CC (1994) The reverse lateral arm flap, based on the interosseous recurrent artery, for cubital fosse burns. Br J Plast Surg 47:341–345
Sbitany U, Wray RC Jr (1986) Use of the rectus abdominis muscle flap to reconstruct an elbow defect. Plast Reconstr Surg 77:988
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Tripathy, S., Khan, A.H. & Sharma, S. Clinical study of the recurrent flaps of the arm for resurfacing of elbow defects. Eur J Plast Surg 33, 23–28 (2010). https://doi.org/10.1007/s00238-009-0371-2
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DOI: https://doi.org/10.1007/s00238-009-0371-2