A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects

Prantl, L.; Schreml, S.; Schwarze, H.; Eisenmann-Klein, M.; Nerlich, M.; Angele, P.; Jung, M.; Füchtmeier, B.

doi:10.1016/j.bjps.2007.05.015

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 61, Issue 5 , Pages 546-551, May 2008

A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects

L. Prantl
- Department of Plastic Surgery, University Hospital, Regensburg, Germany
- Corresponding author. Address: Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, DE-93042 Regensburg, Germany. Tel.: +499419446947; fax: +499419446805.
S. Schreml
- Department of Plastic Surgery, University Hospital, Regensburg, Germany
H. Schwarze
- Department of Plastic Surgery, University Hospital, Regensburg, Germany
M. Eisenmann-Klein
- Department of Plastic Surgery, University Hospital, Regensburg, Germany
M. Nerlich
- Department of Trauma Surgery, University Hospital, Regensburg, Germany
P. Angele
- Department of Trauma Surgery, University Hospital, Regensburg, Germany
M. Jung
- Department of Radiology, University Hospital, Regensburg, Germany
B. Füchtmeier
- Department of Trauma Surgery, University Hospital, Regensburg, Germany

Received 21 July 2006; accepted 22 May 2007. published online 09 July 2007.

Summary

The reconstruction of large soft-tissue defects at the elbow is hard to achieve by conventional techniques and is complicated by the difficulty of transferring sufficient tissue with adequate elasticity and sensate skin. Surgical treatment should permit early mobilisation to avoid permanent functional impairment.

Clinical experience with the distal pedicled reversed upper arm flap in 10 patients suffering from large elbow defects is presented (seven male, three female; age 40–70 years). The patient sample included six patients with chronic ulcer, two with tissue defects due to excision of a histiocytoma, and one patient with burn contracture. In the two cases of histiocytoma, defect closure of the elbow's ulnar area was achieved by using a recurrent medial upper arm flap. In the eight other patients we used a flap from the lateral upper arm with a flap rotation of 180°. Average wound size ranged from 4 to 10cm, average wound area from 30 to 80cm². Flap dimensions ranged from 15×8cm for the lateral upper arm flap to 29×8cm for the medial upper arm flap. The inferior posterior radial and ulnar collateral arteries are the major nutrient vessels of the reversed lateral and medial upper arm flaps. Perforating vessels are identified preoperatively using colour Doppler ultrasonography.

Flap failure did not occur. Secondary wound closure became necessary due to initial wound healing difficulties in one patient. Mean operation time was 1.5h and mean follow-up period 12 months. Good defect coverage with tension-free wound closure was achieved in all cases. Stable defect coverage led to long-term wound stability without any restriction of elbow movement.

The lateral and medial upper arm flaps represent a safe and reliable surgical treatment option for large elbow defects. The surgical technique is comparatively simple and quick.

Keywords: Elbow defect, Upper arm flap, Distal pedicled flap, Early mobilisation