Chungbuk National University Hospital, Cheongju, Korea.
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Wound Manag Prev. 2020 Mar;66(3):40-47.
Treating soft tissue defects occurring over the posterior elbow is challenging.
This study aimed to evaluate the long-term outcomes of using rotation flaps for soft tissue defects over the posterior elbow.
A retrospective study was conducted among patients who had sustained posterior elbow defects and underwent rotation flap under local anesthesia between January 2, 2011, and December 31, 2014. Patient inclusion criteria stipulated the soft tissue defect had to be small (<12 cm2), was the result of wound dehiscence following posterior approach surgery immediately following trauma, and had failed to heal using nonsurgical treatment or primary closure. Patients with an active infection, malignancies, a defect of any etiology other than trauma, or incomplete operative data were excluded. Patient demographics, medical history, operative reports, and outcomes were abstracted. Flap failure and surgical complications were monitored for a minimum of 2 years after surgery. Range of motion (ROM; 0˚ to normal 130˚) and Mayo Elbow Performance Scores (MEPS) were evaluated and recorded before surgery and after 2 years' follow-up and included evaluating pain, ROM, stability, and daily function. Patient, wound, surgical, and wound healing variables were compared between the flap survival and flap failure/complication groups using Mann-Whitney U and chi-squared tests. The Wilcoxon signed-rank test was used to compare pre- and postoperative MEPS and elbow ROM.
Thirty (30) patients (13 male, 17 female; mean age 55 ± 15.6 [range 19-74] years) had complete records. Eighteen (18) flaps were created using the transolecranon approach, and 12 rotation flaps involved an olecranon fracture; 24 flaps survived and 6 patients experienced flap failure/complications (wound dehiscence or infection). Mean procedure duration was 25.6 ± 10.1 minutes. All defects were located over the olecranon with exposed bone or hardware. Mean defect size was 7.4 cm2 ± 2.9 cm2, the average defect duration was 60.4 (range 31-89) days, average time to wound healing was 21.9 ± 11.5 days, and mean follow-up time was 29.4 (range 24-56) months. All flaps successfully survived without recurrence. Mean pre- and postoperative MEPS were significantly different (56.4 vs. 90.2 points; P <.001). ROM did not differ significantly between mean preoperative range (extension 9.8˚ ± 3.2˚ and flexion 116.7˚ ± 10.2˚) and mean final follow-up range (extension 9.6˚ ± 2.6˚ and flexion 118.5˚ ± 11.3˚; P = .459).
Rotation flap surgery performed under local anesthesia may offer a simple and safe option in the treatment of small (<12 cm2) trauma-related defects over the posterior elbow. More research is needed to develop evidence-based guidelines for optimal approaches to posterior elbow soft tissue defect closure techniques.
治疗发生在后肘的软组织缺损具有挑战性。
本研究旨在评估使用旋转皮瓣治疗后肘软组织缺损的长期结果。
对 2011 年 1 月 2 日至 2014 年 12 月 31 日期间因创伤后后路手术切口裂开而导致后肘软组织缺损并在局部麻醉下行旋转皮瓣的患者进行回顾性研究。患者纳入标准规定，软组织缺损必须小于 12cm2，为创伤后后路手术切口裂开的结果，且非手术治疗或一期闭合治疗无效。排除有活动性感染、恶性肿瘤、任何病因引起的缺损（非创伤）或手术资料不完整的患者。提取患者的人口统计学、病史、手术报告和结果。术后至少 2 年监测皮瓣失败和手术并发症。术前和术后 2 年随访时评估和记录关节活动度（0°至正常 130°）和 Mayo 肘功能评分（MEPS），包括评估疼痛、关节活动度、稳定性和日常功能。使用 Mann-Whitney U 和卡方检验比较皮瓣存活组和皮瓣失败/并发症组之间的患者、伤口、手术和伤口愈合变量。Wilcoxon 符号秩检验用于比较术前和术后 MEPS 和肘 ROM。
30 例患者（男 13 例，女 17 例；平均年龄 55±15.6[19-74]岁）有完整记录。18 个皮瓣采用经鹰嘴入路，12 个旋转皮瓣涉及鹰嘴骨折；24 个皮瓣存活，6 例患者出现皮瓣失败/并发症（伤口裂开或感染）。平均手术时间为 25.6±10.1 分钟。所有缺损均位于鹰嘴，伴有骨或内固定器外露。平均缺损大小为 7.4cm2±2.9cm2，平均缺损持续时间为 60.4（31-89）天，平均愈合时间为 21.9±11.5 天，平均随访时间为 29.4（24-56）个月。所有皮瓣均成功存活，无复发。术前和术后 MEPS 平均差异显著（56.4 分比 90.2 分；P<0.001）。术前平均关节活动度（伸展 9.8°±3.2°和屈曲 116.7°±10.2°）与最终随访时的平均关节活动度（伸展 9.6°±2.6°和屈曲 118.5°±11.3°）无显著差异（P=0.459）。
局部麻醉下进行旋转皮瓣手术可能为后肘小（<12cm2）创伤相关缺损的治疗提供一种简单、安全的选择。需要更多的研究来制定最佳后肘软组织缺损闭合技术的循证指南。
