Perforator flap reconstruction for post-burn flexion contracture of the elbow joint

Post-burn elbow flexion contractures significantly impair upper-limb function by restricting the essential functional arc of motion required for activities such as self-care, feeding, hygiene, and vocational tasks. Standard management using contracture release and skin grafting is limited by high rates of recontracture due to secondary graft contraction. Locoregional perforator flaps based on the radial recurrent or ulnar recurrent vessels are often missed, even though they offer thin, pliable, and durable tissue. This study evaluates the flap surface area required to resurface the elbow flexure crease and analyzes postoperative functional outcomes using the Mayo Elbow Performance Score (MEPS).

A prospective observational study was conducted over a three-year period in a tertiary care plastic surgery department. Patients aged 12 years and older presenting with post-burn elbow flexion contractures and with either the radial or ulnar border of the arm unaffected were included. Flap area was estimated from the contralateral limb or an age- and sex-matched individual in bilateral cases. Radial recurrent artery perforator (RRAP) or ulnar recurrent artery perforator (URAP) flaps were harvested based on perforator availability. MEPS was recorded preoperatively and at 6 weeks postoperatively. Early mobilization was initiated within 48 h, and donor sites were grafted as needed.

Twelve patients out of 38 (31%) (eight males, four females; mean age, 34 years) met the inclusion criteria. Flame burns accounted for 9 cases, and scald injuries for 3. The mean flap area required to reconstruct the flexure crease was 39 cm². Preoperatively, elbow function was markedly limited, with a mean MEPS of 60 (range 45-70). Following contracture release and flap resurfacing, early mobilization was achieved in all patients without the need for postoperative splinting. At 6 weeks, the mean MEPS improved significantly to 98 (range 95-100), confirmed by Wilcoxon rank-sum testing (p< 0.05). No flap failures, wound complications, or early recontractures were noted.

Radial and ulnar recurrent artery perforator flaps provide reliable, thin, and contour-appropriate tissue for resurfacing the elbow flexure crease after burn contracture release. Their ability to permit early mobilization and prevent recontractures makes them an effective primary reconstructive option in about 31% of cases.