Use of propeller flaps for reconstruction of extensor side elbow defects

Abstract

Introduction: Extensor side elbow defects are difficult to repair among upper extremity injuries. The bulk of surrounding soft tissue is limited and often affected by the trauma, although seems to be ideal, propeller flaps are not being widely adopted for upper extremity soft-tissue reconstructions. In the present study, we set out to share the results of the perforator propeller flaps that are based on either the arm or the forearm, which we thought the perforator vessel anatomy is relatively constant. Patients and Methods: All patients who underwent elbow defect repair between June 2016 and June 2018 were evaluated retrospectively. Patients were evaluated in terms of the etiology and demographic parameters. Flaps were assessed by the artery system, on which they were based on the dimensions of skin island, the rotation angle of the skin paddle, and closure method of the donor site. Outcomes were noted during bimonthly follow-up visits. Results: In 11 patients, the dominant etiology was chronic bursitis. The mean flap skin paddle size was 48.8 ± 16.9 cm2. For defect repair, radial collateral artery (RCA) perforator flaps were used in six patients. Posterior interosseous artery (PIA) perforator flaps were used in remaining five patients. All the flaps were based on a single perforator artery. The mean rotation degree was measured as 165° ±11.6°. In nine cases, the flap donor site was closed primarily, whereas split-thickness skin grafts were used in two cases. The average follow-up period was 13 ± 5 months. No limitation in the range of motion of the elbow joint was noted. Distal marginal necrosis was observed in two flaps. Conclusion: We advocate that both PIA and RCA perforator flaps are very useful options for soft-tissue reconstruction of extensor side elbow defects.