Elbow Edge Flexion Contracture: Anatomy and Treatment with Local Trapezoid Flaps

Abstract

Burn scars of elbow flexion lateral surfaces, growing distally, form a fold along the elbow fossa’s edges, connecting and approaching the shoulder and arm. Scars that undergo repeat trauma from joint movement grow more aggressively. The ulcers on the fold crest limit the use of the extremity due to pain. Therefore, an early reconstruction is needed. Triangular local flap techniques are most often used. Our observations showed that triangular scar flaps are short, their ends have unstable circulation, and necrosis often appears. The triangular flap’s form does not match the scar surface deficit (which is the cause of the contracture). The different qualities of the fold’s sheets and the counter transposed flaps do not allow surgeons to achieve good outcomes. The resulting incomplete contracture release leads to recurrence and repeated reconstructions. Our experience showed that the most effective local-flap technique for complete edge elbow contracture elimination is trapeze-flap plasty, based on trapezoid elbow healthy flap and flaps prepared from the fold’s sheets. Surgical techniques and outcomes are presented in this chapter.