Arm and forearm island axial flaps for the treatment of IV degree burns in the elbow joint area

Abstract

Among the burns, the quantity of which in our country is substantially reducing, local burns of IV degree in the elbow area occur very seldom: one case in 2–3 years. The elbow joint has a complex structure; it has a thin soft tissue covering, particularly over the elbow olecranon and epicondyles. Joint exposure and bone damage, especially with conservative treatment, could lead to the development of purulent arthritis and ankylosis. Performing split skin grafting for integument restoration, even with surviving graft, gives poor functional results due to skin and bone adhesion. Using non-free skin plasty allows to save the joint, however this requires a fixed position for several weeks. This article discusses various types of replacements for limited deep defects after burns with bone damage in the elbow joint area, performed on 6 male patients by means of applying island axial flaps from the arm (lateral – 2), forearms (radial – 2; ulnar – 1; back – 1). Patient age: from 30 to 76 years. Burn etiolology: contact – 3, electrical – 2, flame – 1. Defects sizes: minimum 7–4 cm, maximum 13–-10 cm. The operations on integument restoration were performed within 3 to 6 weeks after the burn. In one case 2 weeks immobilisation with an external fixation was required. No arthritis developed. Satisfactory functional results received. No essential infringement of hand blood supply registered.The major drawback of all donor zones, which is particularly important for women, is a visible cosmetic defect as a result of using a free skin graft for donor wound plasty. Non-free skin plasty by temporary pedical flap – a reserve method.