Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

Abstract

BackgroundComplex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner.MethodsA retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study.ResultsWe present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from 4×9 cm (36 cm2) to 15×30 cm (450 cm2) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was 102° (range, 45° to 140°).ConclusionsIn our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

Distal Humeral AO type C Fracture - Analysis of LCP Fixation

“…W trak cie ba da nia i le cze nia trze ba pa mię tać o tkan kach mięk kich, któ re wy ma ga ją oceny, za opa trze nia, wpły wa ją na spo sób i wy nik koń -co wy te ra pii [1,3,9,10].…”

“…Po wy ższe za ło że nia mo żna osią gnąć tyl ko ope ra cyj nie, spo sób po stę po wa nia i ze spo le nia uza le żnio ny jest od ro dzaju zła ma nia, mo żli wo ści i umie jęt no ści chi rur ga. Rekon struk cja z uży ciem dwóch blo ko wa nych pły tek po ło żo nych w ob rę bie koń ca dy stal ne go ko ści ra miennej umo żli wia od two rze nie ana to mii, za pew nia najwięk szą sta bil ność w ob rę bie znisz czo nej ko ści jest pre fe ro wa nym spo so bem po stę po wa nia [2,[8][9][10][11][12][13][14][15]. Chirurg ana li zu jąc mor fo lo gię zła ma nia do ko nu je wy bo ru ro dza ju i spo so bu umiej sco wie nia pły tek (pro sto pa dle, rów no le gle) oraz liczby i ro dza ju śrub sta bi li zują cych płyt ki [3,8].…”

“…W ze spo le niu roz ka wał ko wa nej, czę sto zmie nio nej oste opo ro tycz nie ko ści za sto so wa nie znaj du ją ana tomicz ne płyt ki LCP o ogra ni czo nym kon tak cie z kością [2,9]. Ist nie ją dwie mo żli wo ści kon fi gu ra cji pły -tek: a) 90-90 (pro sto pa dle do sie bie), b) rów no le gle do sie bie [2][3][4][5][6][7][8][10][11][12][13][14][15][16].…”

“…Soft tissues must not be ignored during diagnostic work-up and treatment: they require eva lu ation and appropriate management and influence the course and result of the treatment [1,3,9,10].…”

“…The surgical management and method of fixation depend on fracture type, possibilities for intervention and the surgical skill of the operator. Reconstruction with two locking plates located in the distal humerus allows for restoration of bone anatomy and provides for the best stability of the damaged bone fragment, thus being the preferred management of such fractures [2,[8][9][10][11][12][13][14][15]. Having considered fracture morphology, the sur geon decides on the type of plates, their positioning (perpendicular vs parallel) as well as the number and type of screws that should be used to stabilize the plates [3,8].…”