Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review

Abstract

The anatomical basis of the flap's harvesting and the possibilities of elbow coverage are discussed through the selected articles. The different indications according to the areas of soft tissues defects are considered.

Management of Posttraumatic Posterior Elbow Defects by Nonmicrosurgical Reconstruction

“…Gandolfi et al reported use of propeller flaps based on radial collateral artery perforator and posterior ulnar recurrent artery perforator for elbow defect coverage. 7 Propeller flaps in our study were based on perforators from RRA similar to that reported by Panse and Sahasrabudhe. 14 Islanded perforator flaps based on PURA for elbow coverage resulted in better donor site cosmesis as reported by Mateev et al 15 The PURA flap provides a large skin paddle extending proximally up to midarm and comprising almost the entire medial circumference of the arm enabling coverage of complex moderate to large laterally located defects.…”

“…Gandolfi et al reported use of propeller flaps based on radial collateral artery perforator and posterior ulnar recurrent artery perforator for elbow defect coverage. 7 Propeller flaps in our study were based on perforators from RRA similar to that reported by Panse and Sahasrabudhe. 14 Islanded perforator flaps based on PURA for elbow coverage resulted in better donor site cosmesis as reported by Mateev et al 15…”

“…Their study also included RFF, brachioradialis, pedicled LD, and local perforator flaps as coverage options for posterior elbow that correlates with our case series. The RLA flap can also be based anterior to the lateral epicondyle to include perforators of RRA in the flap base, which minimizes the kink and prevents venous congestion as suggested by Devale et al 6 In a recent review article by Gandolfi et al, 7 the lateral arm flap was the most reported flap in their review due to its obvious advantages.…”

Free flap reconstruction of elbow soft tissue defects: Lessons learned from 15 years of experience

“…Coverage options broadly include primary closure, local fasciocutaneous flaps (e.g., medial or lateral arm/forearm flaps), local muscular flaps (e.g., anconeus flap, brachioradialis flap), regional pedicled flaps (e.g., latissimus dorsi flap, thoracodorsal perforator flap), distant pedicled flaps (e.g., paraumbilical perforator flaps), and free tissue transfer (Elhassan et al, 2011; Gutwein et al, 2015; Kahramangil et al, 2022; Rogachefsky et al, 2002; Stevanovic & Sharpe, 2013; Tung et al, 1997; Türegün et al, 2005; Zampeli et al, 2019). In addition to patient comorbidities and other patient selection factors that are predictive of successful reconstruction, size of the defect, etiology of the wound, and the presence of concomitant bony and neurovascular injury are important considerations when selecting the optimal method for achieving definitive soft tissue coverage (Adkinson & Chung, 2014; Gandolfi et al, 2018; Jensen & Moran, 2008; Kelley & Chung, 2015; Patel & Higgins, 2013; Stevanovic & Sharpe, 2013).…”

“…The posterior elbow features thickened skin to facilitate adequate support given the load‐bearing nature of the joint. At the same time, native elbow soft tissue is highly pliable to facilitate functional range of motion (Chapleau et al, 2013; Gandolfi et al, 2018; Kelley & Chung, 2015).…”