Gandolfi Silvia, Auquit-Auckbur Isabelle, Poirot Yoann, Bonmarchand Albane, Mouton Jordane, Carloni Raphael, Nseir Iad, Duparc Fabrice
Department of Plastic, Reconstructive and Hand Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France.
Department of Orthopedic Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France.
Surg Radiol Anat. 2018 Aug;40(8):943-954. doi: 10.1007/s00276-018-2066-5. Epub 2018 Jul 10.
The elbow joint is particularly exposed to soft tissue injuries associated with fractures and dislocations. Different coverage options within the past decades for recovering loss of soft tissue defects around the elbow region have been proposed based on anatomical research. Our aim was to make an updated focus on the anatomical basis of different techniques of coverage of loss of tissues around the elbow.
The main procedures of flaps were defined: local random, axial fasciocutaneous, local muscle pedicle, propeller and free microvascular flaps. A systematic literature review on anatomical basis on these different flaps options was conducted searching on PubMed databases and the selection process was undergone according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. Inclusion criteria were: review and original articles, including anatomical basis of the procedures, in English and French languages.
The final analysis included 37 relevant articles out of 1499 published references. 640 flaps were referenced, for covering 302 elbows. Local random flaps provide a good quality skin for small tissue defects in posterior elbow and periolecranon area, and depend on dermal and subdermal blood supply. Axial fasciocutaneous flaps have well-defined blood supplies and are designed as peninsular, island, or microvascular free flaps, as the radial forearm, lateral arm, ulnar artery, antecubital fasciocutaneous, and posterior interosseous flaps. Muscular flaps have advantages as strength, capacity to contrast local infection and to avoid empty spaces, and can be used as pedicle or as free transfers. Propeller flaps can be rotated up to 180° around an axis corresponding to the perforator vessel and do not require the sacrifice of a major artery or functional muscle. The concept of perforasome is evoked. Free microsurgical transfers can be proposed to cover any defect around the elbow.
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.
肘关节特别容易受到与骨折和脱位相关的软组织损伤。在过去几十年里，基于解剖学研究提出了不同的覆盖方案，用于修复肘部区域软组织缺损。我们的目的是对肘部周围组织缺损不同覆盖技术的解剖学基础进行更新聚焦。
确定皮瓣的主要手术方式：局部随意皮瓣、轴型筋膜皮瓣、局部肌蒂皮瓣、推进皮瓣和游离微血管皮瓣。在PubMed数据库上对这些不同皮瓣选择的解剖学基础进行系统的文献综述，并根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行筛选过程。纳入标准为：英文和法文的综述及原创文章，包括手术的解剖学基础。
最终分析纳入了1499篇已发表参考文献中的37篇相关文章。引用了640例皮瓣，用于覆盖302例肘部。局部随意皮瓣为肘部后方和鹰嘴周围区域的小组织缺损提供了质量良好的皮肤，其依赖真皮和皮下血液供应。轴型筋膜皮瓣有明确的血供，可设计为半岛状、岛状或游离微血管皮瓣，如桡动脉前臂皮瓣、上臂外侧皮瓣、尺动脉皮瓣、肘前筋膜皮瓣和骨间后皮瓣。肌皮瓣具有强度大、能对抗局部感染和避免出现空腔的优点，可作为带蒂皮瓣或游离移植。推进皮瓣可围绕与穿支血管对应的轴旋转达180°，且无需牺牲主要动脉或功能肌肉。文中提到了穿支体的概念。可采用游离显微外科移植来覆盖肘部周围的任何缺损。
通过所选文章讨论了皮瓣切取的解剖学基础以及肘部覆盖的可能性。考虑了根据软组织缺损区域的不同适应证。
