Department of General Surgery, Cleveland Clinic Florida, Weston, FL, United States.
Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL, United States.
J Plast Reconstr Aesthet Surg. 2022 Mar;75(3):991-1000. doi: 10.1016/j.bjps.2021.11.091. Epub 2021 Dec 2.
Different elbow flap reconstructions have been described in the literature. We aim to define the optimal flap technique based on defect size and etiology.
A systematic review was undertaken using the terms "(Elbow reconstruction) AND ((Soft tissue) OR (flap))". Flaps were grouped under fasciocutaneous (FCF), muscular (MF), distant pedicled (DPF), and free flaps (FF). The primary outcome was flap survival. The secondary outcomes were postoperative complications and range of motion (pROM).
Twenty articles with 224 patients were included. Defect sizes were small (<10 cm) (18%), medium (10-30 cm) (23%), large (30-100 cm) (43%), and massive (>100 cm) (16%). Etiologies included trauma (26%), burn contractures (26%), infection (26%), hardware coverage (16%), and others (6%). FCF (54%) was the preferred flap followed by MF (28%), DPF (13%), and FF (5%). The rate of flap necrosis was 4% and that of other complications was 10%. The postoperative range of motion (pROM) (reported in 154 patients) was >100°, 50-100°, and <50° in 82%, 17%, and 1% of the cases, respectively. Small defects were most commonly reconstructed with MFs (83%), medium defects were reconstructed with MFs (52%) or FCFs (46%), and large defects were reconstructed with FCFs (91%). Massive defects predominantly required DPFs (60%) and FFs (26%). FCFs were the most common reconstruction method for burn contractures (84%), infections (55%), and traumatic defects (51%). Hardware coverage was predominantly performed using MFs (86%). No difference in complications and pROM was found between flap techniques.
Elbow flap reconstruction can be performed using different techniques. FCFs are the most commonly used reconstruction method. MFs are useful for smaller defects and hardware coverage. DPFs and FFs are needed for massive injuries.
不同的肘部皮瓣重建方法在文献中有描述。我们旨在根据缺陷大小和病因来定义最佳皮瓣技术。
使用术语“（肘部重建）和（软组织）或（皮瓣）”进行系统回顾。皮瓣分为筋膜皮瓣（FCF）、肌肉皮瓣（MF）、远位蒂皮瓣（DPF）和游离皮瓣（FF）。主要结局是皮瓣存活率。次要结局是术后并发症和关节活动度（pROM）。
纳入 20 篇文章共 224 例患者。缺损大小小（<10 cm）（18%）、中（10-30 cm）（23%）、大（30-100 cm）（43%）和巨大（>100 cm）（16%）。病因包括创伤（26%）、烧伤挛缩（26%）、感染（26%）、内置物覆盖（16%）和其他（6%）。FCF（54%）是首选皮瓣，其次是 MF（28%）、DPF（13%）和 FF（5%）。皮瓣坏死率为 4%，其他并发症发生率为 10%。154 例患者报告的术后关节活动度（pROM）分别为>100°、50-100°和<50°，分别占 82%、17%和 1%。小缺损最常采用 MF 重建（83%），中缺损采用 MF（52%）或 FCF（46%）重建，大缺损采用 FCF（91%）重建。巨大缺损主要需要 DPF（60%）和 FF（26%）。FCF 是烧伤挛缩（84%）、感染（55%）和创伤性缺陷（51%）的最常见重建方法。硬件覆盖主要采用 MF（86%）。不同皮瓣技术之间在并发症和 pROM 方面无差异。
肘部皮瓣重建可以采用不同的技术。FCF 是最常用的重建方法。MF 适用于较小的缺损和硬件覆盖。DPF 和 FF 适用于大面积损伤。
