Rescue of a Deep Burned Elbow Using a Radial Forearm Pedicled Flap, an Original Irrigation System and a Specific Immobilization

Abstract

Abstract Deep soft tissue defects next to the joints can rapidly lead to irreversible damages and have to be covered urgently and effectively. In severely burned patients the usual approach is to use a flap even though it has its limitations in regards to the extent of the burn and the general condition of the patient. A 27-year-old male was admitted at the Burn Treatment Center for a thermic burn of 72% of his BSA. At first he has benefited from several skin grafts and later on a major open right elbow had to be treated urgently to rescue the joint. After the burn, a revascularization of the donor site was noticed, sufficient to use the radial forearm pedicled flap as a cover for the elbow. This case reports an innovative approach based on the use of an irrigation and drainage system placed underneath the flap. The elbow was rigidly immobilized with an external fixator in order to facilitate an optimal healing of the flap. In this case, the choice of this flap, combined with the irrigation and drainage system and the immobilization by external fixation, provided an original and efficient treatment. Postoperatively the healing of the flap and of the donor site was complete. The functional results exceeded the expectations with a complete recovery of the joint amplitude. Thus, in case of no other therapeutic options, it is probably possible to use a variety of flaps recently healed.