Related Experiment Video
Updated: Feb 14, 2026
07:57
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
289
From Shrapnel to Stability: A Reverse Perforator Flap for Definitive Elbow Coverage Seven Decades Post-Trauma. A Case
Alvise Montanari1, Cesare Tiengo1, Alfio Luca Costa2
1Plastic Surgery Unit, Department of Neuroscience, University of Padua, Padua 35121, Italy.
Military Medicine
|February 12, 2026
Summary
Wartime shrapnel injuries can cause lifelong elbow complications. Aggressive surgery, including debridement and flap reconstruction, successfully treated chronic osteomyelitis and ulceration in an elderly patient.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Plastic Surgery
Background:
- World War II shrapnel injury in childhood led to elbow fracture and ulnar nerve damage.
- Decades later, the patient developed chronic osteomyelitis with recurrent olecranon ulcerations and scar instability.
Purpose of the Study:
- To detail the lifelong management of a complex wartime shrapnel injury.
- To present a successful surgical reconstruction for chronic elbow osteomyelitis and soft tissue defects.
Main Methods:
- Initial conservative management with antibiotics and scar revision with lipofilling.
- Surgical intervention involving fistulectomy, extensive bone debridement, and soft tissue reconstruction with a reverse-flow perforator flap.
Main Results:
- Successful healing of chronic ulceration and osteomyelitis with no recurrence at five-year follow-up.
- The reverse-flow perforator flap provided a reliable, single-stage reconstructive option for the challenging elbow region.
Conclusions:
- Chronic complications from wartime trauma can manifest throughout a patient's life.
- A definitive surgical approach combining radical debridement and robust soft tissue reconstruction is necessary for long-term management.
- Pedicled flaps offer a viable solution for elderly patients with comorbidities requiring elbow reconstruction.
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