Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, Great Neck, New York, USA.
Microsurgery. 2024 May;44(4):e31163. doi: 10.1002/micr.31163.
The elbow is a complex joint that is vital for proper function of the upper extremity. Reconstruction of soft tissue defects over the joint space remains challenging, and outcomes following free tissue transfer remain underreported in the literature. The purpose of this analysis was to evaluate the rate of limb salvage, joint function, and clinical complications following microvascular free flap coverage of the elbow.
This retrospective case series utilized surgical logs of the senior authors (Stephen J Kovach and L Scott Levin) to identify patients who underwent microvascular free flap elbow reconstruction between January 2007 and December 2021. Patient demographics and medical history were collected from the medical chart. Operative notes were reviewed to determine the type of flap procedure performed. The achievement of definitive soft tissue coverage, joint function, and limb salvage status at 1 year was determined from postoperative visit notes.
Twenty-one patients (14 male, 7 female, median age 43) underwent free tissue transfer for coverage of soft tissue defects of the elbow. The most common indication for free tissue transfer was traumatic elbow fracture with soft tissue loss (n = 12, [57%]). Among the 21 free flaps performed, 71% (n = 15) were anterolateral thigh flaps, 14% (n = 3) were latissimus dorsi flaps, and 5% (n = 1) were transverse rectus abdominis flaps. The mean flap size was 107.5 cm. Flap success was 100% (n = 21). The following postoperative wound complications were reported: surgical site infection (n = 1, [5%]); partial dehiscence (n = 5, [24%]); seroma (n = 2, [10%]); donor-site hematoma (n = 1, [5%]); and delayed wound healing (n = 5, [24%]). At 1 year, all 21 patients achieved limb salvage and definitive soft tissue coverage. Of the 17 patients with functional data available, 47% (n = 8) had regained at least 120 degrees of elbow flexion/extension. All patients had greater than 1 year of follow-up.
Microvascular free flap reconstruction is a safe and effective method of providing definitive soft tissue coverage of elbow defects, as evidenced by high rates of limb salvage and functional recovery following reconstruction.
肘部是一个复杂的关节，对于上肢的正常功能至关重要。关节间隙的软组织缺损重建仍然具有挑战性，并且文献中对游离组织转移后的结果报道较少。本分析的目的是评估游离皮瓣覆盖肘部后肢体挽救率、关节功能和临床并发症的情况。
本回顾性病例系列研究利用高级作者（Stephen J Kovach 和 L Scott Levin）的手术记录，确定 2007 年 1 月至 2021 年 12 月期间接受游离皮瓣肘部重建的患者。从病历中收集患者的人口统计学和病史数据。回顾手术记录以确定进行的皮瓣手术类型。从术后就诊记录中确定 1 年后的确定性软组织覆盖、关节功能和肢体挽救状态。
21 例患者（男 14 例，女 7 例，中位年龄 43 岁）因肘部软组织缺损接受游离组织转移。游离组织转移的最常见适应证是创伤性肘部骨折伴软组织缺失（n=12，[57%]）。在 21 例游离皮瓣中，71%（n=15）为股前外侧皮瓣，14%（n=3）为背阔肌皮瓣，5%（n=1）为腹直肌皮瓣。皮瓣平均大小为 107.5cm。皮瓣成功率为 100%（n=21）。报告了以下术后伤口并发症：手术部位感染（n=1，[5%]）；部分裂开（n=5，[24%]）；血清肿（n=2，[10%]）；供区血肿（n=1，[5%]）；和伤口愈合延迟（n=5，[24%]）。1 年后，21 例患者均成功挽救肢体并获得确定性软组织覆盖。在 17 例有功能数据的患者中，47%（n=8）恢复了至少 120 度的肘部屈伸。所有患者均随访 1 年以上。
游离皮瓣重建是提供肘部缺陷确定性软组织覆盖的安全有效方法，重建后肢体挽救率和功能恢复率高证明了这一点。
