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Olecranon Bursectomy with De-Epithelialized Advancement Flap Reconstruction: A Novel Surgical Approach
Caroline E. Kettering, BS
Francesco M. Egro MBChB, MSc, MRCS
Guy M. Stofman MD, FACS
University of Pittsburgh School of Medicine
2020-01-27
Presenter: Caroline E. Kettering
Affidavit:
This study is the original work of the authors.
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Olecranon bursitis is common, yet there is no standardized treatment. Conservative methods are preferred due to high rates of complication and recurrence with surgery. However, we present 2 cases using a novel surgical technique, an open bursectomy with a de-epithelialized advancement flap reconstruction, that reduces the risk of complication and recurrence.
Methods: For the excisional portion of the surgical technique, the olecranon bursa was removed under direct vision. Next, the ulnar skin flap was de-epithelialized and buried under the most radial aspect of the wound, obliterating any dead space. The overlying radial skin flap was used to close the defect, creating a double layer of tissue over the elbow. Patients were followed post-operatively for complications and recurrence.
Results: In October 2010, an 80-year-old male with history of gout and chronic right olecranon bursitis had a 6x4cm bursa removed using the surgical approach described above. He was followed until the end of his life (6 years post-op) with no complications and no recurrence.
The second patient (66yo M), with chronic left olecranon bursitis of traumatic etiology, had a 5cm bursa removed in March 2019, using the same technique. Like the first case, the wound healed without complication, full range of motion and strength were recovered, and there was no recurrence of bursitis.
Discussion/Conclusion: We present a novel surgical technique that has many advantages by eliminating dead space around the defect and creating a strong, multi-layer closure. We hope it will benefit the wider community for olecranon bursitis treatment.
