Background
Chronic elbow wounds present a challenging reconstructive problem. Appropriate reconstruction requires bulk over the bony prominences; and coverage over the triceps tendon and ulnar nerve to maximise upper limb function. This illustrative case series delineates operative steps to maximise the reach, reliability and minimise donor site morbidity of pedicled radial forearm flaps in elbow soft tissue reconstruction.
Methods
Case 1 is a 70-year-old gentleman who presented with streptococcal septicaemia with a cutaneous source from the left arm. He underwent serial debridement, use of a biodegradable temporising matrix (BTM), vacuum assisted closure (VAC) dressing and split thickness skin graft. Following a fall, he sustained a traumatic wound to the grafted olecranon and an avulsion fracture of the triceps tendon. Case 2 is a 86-year-old gentleman who had a traumatic laceration to his elbow, underwent an olecranon bursectomy and had three failed attempts at closure. He also sustained a triceps avulsion fracture post initial injury. Both patients underwent reconstruction with a pedicled radial forearm flap.
Results
The following technique was successfully adopted in the reconstruction of these elbow wounds. Technical refinements included meticulous wound debridement (methylene blue marking), accurate templating and planning the flap in reverse, including the lateral femoral cutaneous nerve for sensory preservation, creating a submuscular tunnel under brachioradialis for flap passage as well as fractional lengthening of the brachioradialis tendon to minimise pedicle tension.
Conclusion
The radial forearm flap should be considered as a robust reconstructive modality for recalcitrant elbow soft tissue defects.