A 19-Year Experience With Clavicular Defects: An Algorithm for Flap Selection and Surgical Outcomes.

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Clavicle bone defects are rare and present variable management challenges.
• The clavicle is vital for shoulder stability and function.
• Effective reconstruction strategies for clavicle defects are essential.

Purpose of the Study:

• To evaluate the effectiveness of various flap reconstructions for clavicle bone defects.
• To assess functional recovery in patients with clavicle defects and upper limb impairment.
• To propose an algorithm for managing clavicle bone defects.

Main Methods:

• Retrospective analysis of six patients with clavicle bone defects.
• Reconstruction using pedicled pectoralis major myocutaneous flap and bone flaps (fibular, iliac, rib).
• Evaluation of flap success, complications, and functional outcomes.

Main Results:

• All flaps achieved successful wound repair, with minor complications in one pedicled rib flap and one free fibular flap.
• Four free flaps and two pedicled flaps were utilized.
• Significant functional improvements were observed in five patients with upper limb impairment.

Conclusions:

• Soft tissue flaps are necessary for wound closure in clavicle defects with soft tissue loss.
• Bone flaps, especially fibular flaps, are critical for functional recovery of the upper limb.
• Flap selection should consider defect size, soft tissue status, and ipsilateral limb function, guided by a proposed algorithm.