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CC BY-NC 4.0 · Arch Plast Surg 2012; 39(02): 130-136
DOI: 10.5999/aps.2012.39.2.130
Original Article

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

Christopher Hoe-Kong Chui
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Chin-Ho Wong
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Winston Y Chew
Department of Orthopaedic Surgery (Hand and Microsurgery), Tan Tock Seng Hospital, Singapore
,
Mun-Hon Low
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
,
Bien-Keem Tan
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Background Complex 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.

Methods A 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.

Results We 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°).

Conclusions In 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.

Keywords

Free tissue flaps - Elbow joint - Reconstructive surgical procedures

This article was present at Chang Gung Mayo Clinic Symposium in Reconstructive Surgery, October 27-30, 2011.




Publication History

Received: 06 December 2011

Accepted: 15 January 2012

Article published online:
24 April 2022

© 2012. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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