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CC BY-NC 4.0 · Arch Plast Surg 2012; 39(02): 130-136
DOI: 10.5999/aps.2012.39.2.130
Original Article

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

Christopher Hoe-Kong Chui
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Chin-Ho Wong
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Winston Y Chew
Department of Orthopaedic Surgery (Hand and Microsurgery), Tan Tock Seng Hospital, Singapore
,
Mun-Hon Low
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
,
Bien-Keem Tan
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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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 4×9 cm (36 cm2) to 15×30 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 102° (range, 45° to 140°).

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.

Keywords

Free tissue flaps - Elbow joint - Reconstructive surgical procedures

This article was present at Chang Gung Mayo Clinic Symposium in Reconstructive Surgery, October 27-30, 2011.




Publication History

Received: 06 December 2011

Accepted: 15 January 2012

Article published online:
24 April 2022

© 2012. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Sojbjerg JO. The stiff elbow. Acta Orthop Scand 1996; 67: 626-631
    CrossrefPubMedSearch in Google Scholar
  • 2 Choudry UH, Moran SL, Li S. et al. Soft-tissue coverage of the elbow: an outcome analysis and reconstructive algorithm. Plast Reconstr Surg 2007; 119: 1852-1857
    CrossrefPubMedSearch in Google Scholar
  • 3 Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010; 32: 529-540
    PubMedSearch in Google Scholar
  • 4 Tan BK, Wong CH, Chew W. et al. Use of the slit arteriotomy for end-to-side arterial anastomosis in free-tissue transfers to the extremities. J Plast Reconstr Aesthet Surg 2009; 62: 1519-1523
    CrossrefPubMedSearch in Google Scholar
  • 5 Lee DH. Treatment options for complex elbow fracture dislocations. Injury 2001; 32 (Suppl. 04) SD41-SD69
    PubMedSearch in Google Scholar
  • 6 Hallock GG. The utility of both muscle and fascia flaps in severe upper extremity trauma. J Trauma 2002; 53: 61-65
    CrossrefPubMedSearch in Google Scholar
  • 7 Jensen M, Moran SL. Soft tissue coverage of the elbow: a reconstructive algorithm. Orthop Clin North Am 2008; 39: 251-264
    CrossrefPubMedSearch in Google Scholar
  • 8 Wong CH, Wei FC, Fu B. et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 2009; 123: 571-577
    CrossrefPubMedSearch in Google Scholar
  • 9 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26: 759-769
    CrossrefPubMedSearch in Google Scholar
  • 10 Chen SL, Chen TM, Wang HJ. Free thoracodorsal artery perforator flap in extremity reconstruction: 12 cases. Br J Plast Surg 2004; 57: 525-530
    CrossrefPubMedSearch in Google Scholar
  • 11 Kim JT, Koo BS, Kim SK. The thin latissimus dorsi perforator-based free flap for resurfacing. Plast Reconstr Surg 2001; 107: 374-382
    CrossrefPubMedSearch in Google Scholar
  • 12 Ayhan S, Tuncer S, Demir Y. et al. Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects. J Reconstr Microsurg 2008; 24: 285-293
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Koshima I, Nanba Y, Tsutsui T. et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 2004; 113: 233-240
    CrossrefPubMedSearch in Google Scholar
  • 14 Mardini S, Lin LC, Moran SL. et al. Anterolateral thigh flap. In: Wei FC, Mardini S. Flaps and reconstructive surgery. 2009. Philadelphia: Elsevier; 538-558
    Search in Google Scholar
  • 15 Cho HK, Lee DJ, Cha JH. et al. Nerve regeneration after autogenous nerve graft using perfabricated adiponeural and myoneural flap: an experimental study. J Korean Soc Plast Reconstr Surg 2000; 27: 65-71
    Search in Google Scholar
  • 16 Prpa B, Huddleston PM, An KN. et al. Revascularization of nerve grafts: a qualitative and quantitative study of the soft-tissue bed contributions to blood flow in canine nerve grafts. J Hand Surg Am 2002; 27: 1041-1047
    CrossrefPubMedSearch in Google Scholar
  • 17 Koshima I, Nanba Y, Tsutsui T. et al. Vascularized femoral nerve graft with anterolateral thigh true perforator flap for massive defects after cancer ablation in the upper arm. J Reconstr Microsurg 2003; 19: 299-302
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125: 209-214
    CrossrefPubMedSearch in Google Scholar
  • 19 Townley WA, Royston EC, Karmiris N. et al. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011; 64: 1621-1626
    CrossrefPubMedSearch in Google Scholar
  • 20 Wei FC, Jain V, Suominen S. et al. Confusion among perforator flaps: what is a true perforator flap?. Plast Reconstr Surg 2001; 107: 874-876
    CrossrefPubMedSearch in Google Scholar
  • 21 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97: 985-992
    CrossrefPubMedSearch in Google Scholar
  • 22 Kimata Y, Uchiyama K, Ebihara S. et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 1997; 123: 1325-1331
    CrossrefPubMedSearch in Google Scholar
  • 23 Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 1981; 63: 872-877
    CrossrefPubMedSearch in Google Scholar
  • 24 Keschner MT, Paksima N. The stiff elbow. Bull NYU Hosp Jt Dis 2007; 65: 24-28
    PubMedSearch in Google Scholar
  • 25 Evans PJ, Nandi S, Maschke S. et al. Prevention and treatment of elbow stiffness. J Hand Surg Am 2009; 34: 769-778
    CrossrefPubMedSearch in Google Scholar