Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review
- 122 Downloads
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.
Materials and methods
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.
Discussion and conclusion
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.
KeywordsElbow Reconstructive surgery Muscular flaps Pedicle flaps Propeller flaps
- 1.Avashia YJ, Shammas RL, Poveromo LP, Dekker TJ, Brubacher JW, Richard MJ, Ruch DS, Mithani SK (2018) Forearm based turnover muscle flaps for elbow soft tissue reconstruction: a comparison of regional coverage based on distal flap perfusion. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000004472 PubMedCrossRefGoogle Scholar
- 5.Camuzard O, Foissac R, Clerico C, Fernandez J, Balaguer T, Ihrai T, de Peretti F, Baqué P, Boileau P, Georgiou C, Bronsard N (2016) Inferior cubital artery perforator flap for soft-tissue coverage of the elbow: anatomical study and clinical application. J Bone Jt Surg Am 98(6):457–465CrossRefGoogle Scholar
- 10.Cil Y, Kocabiyik N, Ozturk S, Isik S, Ozan H (2010) A new perforator flap from distal medial arm: a cadaveric study. Eplasty 10:541–548Google Scholar
- 43.Schmidt CC, Kohut NG, Greenberg JA, Kann SE, Idler RS, Kiefhaber TR (1999) The anconeus muscle flap: its anatomy and clinical application. J Hand Sur Am 4(2):359–369Google Scholar
- 45.Sharpe F, Stevanovic M, Itamura JM (2004) Soft tissue coverage of the elbow. In: Mirzayan R, Itamura JM (eds) Shoulder and elbow trauma. Thieme, New York, p 89Google Scholar
- 53.Yang GF, Chen PJ, Gao YZ et al (1981) Forearm free skin flap transplantation. Chin Med J 61:139–141Google Scholar