Ulus Travma Acil Cerrahi Derg. 2009; 15(6): 591-598

The reconstruction of soft tissue defects in the elbow area: a treatment algorithm proposal

Ahmet Duymaz, Furkan Erol Karabekmez, Mustafa Keskin, Zekeriya Tosun, Nedim Savaci
Selcuk University, Meram Faculty Of Medicine, Department Of Plastic And Reconstructive Surgery

BACKGROUND
The reconstruction of soft tissue defects of the elbow area (including antecubital fossa and peri-olecranon area) should be performed with the most appropriate soft tissue and functional rehabilitation immediately.
METHODS
Ten patients were included in this study. One had a brachial artery defect, another had postburn axillary contracture deformity, and a third had an ulnar bone body fracture in addition to their soft tissue defects, while the remaining seven had only soft tissue defect. Patients underwent surgical closure either by local arm fasciocutaneous flap (1), radial forearm flap (1), multiple Z-plasty (1), pedicled latissimus dorsi muscle flap (3), or with the antecubital fasciocutaneous island flap (4).
RESULTS
The follow-up was 9 months to 4 years (mean: 19 months). All the flaps achieved wound closure without losing the range of motion at the elbow joint.
CONCLUSION
Surgical closure of the antecubital fossa and peri-olecranon areas can be a challenge for plastic surgeons since this area includes numerous neuro-vascular bundles and a functional joint. Therefore, we describe herein an algorithm for the treatment of defects in these areas from the inspiration in our clinical experience and a literature review. Our algorithm will help to decide the most appropriate choice among all of the surgical options available.

Keywords: Elbow area, treatment algorithm; wound closure; soft tissue defects.

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Dirsek bölgesi yumuþak doku defektlerinin rekonstrüksiyonu: Tedavi algoritma önerisi

Ahmet Duymaz, Furkan Erol Karabekmez, Mustafa Keskin, Zekeriya Tosun, Nedim Savaci
Selçuk Üniversitesi, Meram Týp Fakültesi, Plastik Cerrahi Ve Rekonstrüktif Anabilim Dalý

AMAÇ
Dirsek bölgesi (antekübital fossa ve periolekranon bölgesi dahil) yumuþak doku defektlerinin rekonstrüksiyonu mümkün olan en kýsa sürede ve en uygun doku ile yapýlmalýdýr. Daha sonra erken fonksiyonel rehabilitasyona baþlanmalýdýr.
GEREÇ VE YÖNTEM
On hasta çalýþmaya dâhil edildi. Yedi hastada sadece yumuþak doku defekti varken kalan üç hastada yumuþak doku defektine ilave olarak 1 hastada brakiyal arter defekti, 1 hastada yanýk sonrasý aksiler kontraktür deformitesi, baþka 1 hastada ulnar kemik cisim kýrýðý vardý. Hastalar lokal kol fasyokunatöz flep (1 hasta), radial önkol flebi (1 hasta), multipl Z-plasti (1 hasta), pediküllü latisimus dorsi kas flebi (3 hasta) ve antekübital fasyokütan ada flepleri (4 hasta) ile cerrahi kapama saðlandý.
BULGULAR
Takip süresi 9 ay ile 4 yýl arasýndaydý (ortalama 19 ay). Tüm fleplerde baþarýyla yara kapamasý saðlandý. Onarým sonrasý eklem hareket açýklýðýnda kayýp olmadý.
SONUÇ
Antekübital fossa ve periolekranon bölgelerinin cerrahi kapamasý bu bölgenin çok sayýda nörovasküler yapý ve fonksiyonel eklemler içermesinden dolayý plastik cerrahlarý zorlamaktadýr. Bu nedenle, klinik deneyimlerimiz ve literatür incelemelerimiz ýþýðýnda bu bölge defektlerinin tedavisi için bir algoritma tanýmladýk. Algoritmamýz birçok cerrahi seçenek arasýnda en uygun olanýna karar vermede faydalý olacaktýr.

Anahtar Kelimeler: Dirsek bölgesi, tedavi algoritmasý; yara kapamasý; yumuþak doku defekti.

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