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Bipedicle Flaps for Posterior Elbow Reconstruction
Kyle J. Chepla MD, Shirley Shue BS, Bram R. Kaufman MD
University training program
2017-02-12
Presenter: Shirley Shue
Affidavit:
The medical student wrote the abstract and also used descriptive statistics to analyze our data on Excel.
Director Name: Kyle J. Chepla
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
HYPOTHESIS:
Bipedicle flaps are a simple, stable and reliable option for local tissue reconstruction of small to medium sized (<50 cm2) posterior elbow defects.
METHODS:
A retrospective chart review was performed for three patients treated with bipedicle advancement flap from 2014-2015. Collected data included; age, gender, medical comorbidities, etiology of the defect, wound size, prior surgical operations, presence of osteomyelitis, surgical complications and time to healing.
RESULTS:
The etiology of the soft tissue elbow defect was chronic infected olecranon bursits (n=2) and exposed olecranon plate after open fracture (n=1). Patient comorbidities included; diabetes, CREST syndrome, and rheumatoid arthritis. The mean age at time of reconstruction was 44 years (39-51), and the mean soft tissue defect area was 39.3 cm2 (24-54 cm2) after debridement. All patients had positive intraoperative cultures and were treated with culture-directed long-term intravenous antibiotics. There were no surgical complications or flap loss. All patients had reepithelialization of the donor site by post-operative week 8 and stable soft tissue coverage of the elbow after surgery at final follow-up with full pre-operative elbow range of motion.
SUMMARY:
Bipedicle flaps recruit local tissue for primary closure of posterior elbow wounds with minimal donor site morbidity and do not require the sacrifice of a local muscle for flap coverage or microvascular surgical skills. This is a fast, straightforward, reliable technique for soft tissue coverage of small to medium sized posterior elbow defects. Appropriate surgical debridement, removal of foreign material and culture directed antibiotics are crucial to a successful surgical outcome.
