Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, Heidelberg University, Heidelberg, Germany.
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, Heidelberg University, Heidelberg, Germany.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:287-295. doi: 10.1016/j.bjps.2024.07.052. Epub 2024 Jul 30.
Comparative data on free flap outcomes for elbow defect reconstruction are still lacking. This study aimed to compare complication rates of free muscle flaps (MFs) versus cutaneous flaps (CFs) for posterior elbow reconstruction.
In a single-center retrospective analysis, patients who underwent posterior elbow reconstruction with free MFs and CFs from 2000 to 2021 were analyzed. Retrospective chart review included patient demographics, operative details, and post-operative complications. Outcomes of interest that were compared included microvascular complications, partial or total flap necroses, wound dehiscence, hematoma or flap infection, and donor-site complications.
Sixty-six free flaps (CFs: n = 42; MFs: n = 24) were included, with a trend over time toward using CFs (64%). MFs were used for larger defects (CF: 175 ± 82 vs. MF: 212 ± 146 cm; p = 0.13). Outcome analysis revealed an equal distribution of microvascular complications (10% vs. 13%; p = 0.7), partial flap necrosis (7% vs. 8%; p > 0.9), wound dehiscence (7% vs. 4%; p > 0.9), evacuation of hematoma (10% vs. 4%; p = 0.7), and infection (0% vs. 4%; p = 0.4). Total flap necrosis requiring additional flap surgery was necessary in one CF (2%) and in no MF (0%) (p > 0.9).
Surgical outcomes, flap necrosis rates, and microsurgical complications did not differ between CFs and MFs. Both flap types are safe and effective options. The free anterolateral thigh and latissimus dorsi flaps represent indispensable workhorses for the reconstruction of extensive elbow defects.
肘部缺损重建中游离皮瓣结果的比较数据仍然缺乏。本研究旨在比较游离肌肉皮瓣（MFs）与皮瓣（CFs）用于后肘部重建的并发症发生率。
在单中心回顾性分析中，分析了 2000 年至 2021 年期间接受游离 MFs 和 CF 后肘部重建的患者。回顾性图表审查包括患者人口统计学、手术细节和术后并发症。比较的感兴趣结果包括微血管并发症、部分或全部皮瓣坏死、伤口裂开、血肿或皮瓣感染以及供区并发症。
共纳入 66 例游离皮瓣（CF：n=42；MF：n=24），使用 CF 的趋势随时间增加（64%）。MF 用于更大的缺损（CF：175±82 与 MF：212±146cm；p=0.13）。结果分析显示，微血管并发症的分布相等（10%与 13%；p=0.7），部分皮瓣坏死（7%与 8%；p>0.9），伤口裂开（7%与 4%；p>0.9），血肿清除（10%与 4%；p=0.7）和感染（0%与 4%；p=0.4）。需要额外皮瓣手术的总皮瓣坏死在 1 例 CF（2%）中发生，在没有 MF 中发生（0%）（p>0.9）。
CFs 和 MFs 之间的手术结果、皮瓣坏死率和显微外科并发症没有差异。两种皮瓣类型都是安全有效的选择。游离股前外侧皮瓣和背阔肌皮瓣是广泛肘部缺损重建的不可或缺的主力皮瓣。
