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Soft-tissue coverage of the elbow: an outcome analysis and reconstructive algorithm.

Umar H Choudry¹, Steven L Moran, Sean Li

¹Rochester, Minn. From the Divisions of Plastic Surgery, Orthopedics, and General Surgery, Mayo Clinic.

Plastic and Reconstructive Surgery

|April 19, 2007

Summary

Reconstructive surgery for elbow soft-tissue defects shows pedicled latissimus dorsi flaps have high complication rates, especially distal necrosis. Radial forearm or free flaps are recommended for better outcomes in elbow defect coverage.

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Area of Science:

Orthopedic Surgery
Plastic Surgery
Reconstructive Surgery

Background:

Elbow soft-tissue defects present significant challenges for reconstructive surgeons.
Limited outcome data exists for various reconstructive techniques in this area.

Purpose of the Study:

To analyze outcomes of soft-tissue coverage for elbow defects.
To determine the benefits and limitations of different reconstructive options for elbow defects.

Main Methods:

Retrospective review of 99 flaps in 96 patients (1988-2005) requiring flap coverage for elbow defects.
Analysis of patient demographics, defect characteristics, flap types, complications, and long-term outcomes.
Statistical comparison using the t test.

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Main Results:

Trauma accounted for 47% of defects; 66% of flaps were pedicled, 19% were free.
Radial forearm flap was the most common pedicled flap; latissimus dorsi muscle flap was the most common free flap.
Overall flap failure rate was 10%. Pedicled latissimus dorsi flaps had a higher complication rate (57%) than radial forearm flaps (p=0.01), with distal necrosis being common.

Conclusions:

Pedicled latissimus dorsi flaps are associated with high distal necrosis rates when used for defects distal to the olecranon.
Radial forearm flaps or free flaps are recommended for soft-tissue coverage over the proximal ulna.