Retrospective analysis of three kinds of pedicled perforator flaps for repairing soft tissue defects around the elbow joint
10.3760/cma.j.cn114453-20230322-00061
- VernacularTitle:三种穿支蒂皮瓣修复肘关节周围软组织缺损的回顾性分析
- Author:
Jian LIN
1
;
Lizhi WU
;
Xiang WANG
;
Tianhao ZHANG
;
Zhijiang WANG
;
Heping ZHENG
Author Information
1. 上海健康医学院附属崇明医院（上海新华医院崇明分院）骨科修复重建中心 上海健康医学院创面防治研究所，上海 202150
- Keywords:
Surgical flaps;
Perforator flap;
Elbow joint;
Soft tissue defect;
Reconstructive surgical procedures
- From:
Chinese Journal of Plastic Surgery
2023;39(9):929-938
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods:The clinical data of patients with soft tissue defects around the elbow joint, admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences (Xinhua Hospital Chongming Branch) from December 2013 to November 2022 were retrospectively analyzed. The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm, the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location, appearance, size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint. The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb. The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects. (1) The self-evaluation of the curative effect was divided into three grades: satisfactory, general and unsatisfactory. (2) Elbow joint function evaluation: according to Mayo’s elbow joint function scoring standard which was divided into four grades: excellent, good, general and poor. (3) Comprehensive evaluation: the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring: 16 to 21 points as excellent, 11 to 15 points as good, 6 to 10 points as general, 0 to 5 points as poor, and the excellent and good ratio was calculated at the same time, that is, the sum of the number of excellent and good cases/the total number of cases×100%.Results:A total of 51 patients were enrolled, including 31 males and 20 females. The age ranged from 16 to 87 years old, with a mean of 56.1 years old. About the defect location, there were 20 cases in the anterior side of the elbow joint, 18 cases in the posterior side of the elbow joint, 8 cases in the medial side of the elbow joint, and 5 cases in the lateral side of the elbow joint. The defect sizes after debridement were from 3.5 cm×2.5 cm to 16.0 cm× 6.0 cm. Among the 51 patients, 21 cases were repaired by the distal based medial antebrachial neurocutaneous flap, 19 cases were repaired by the perforator pedicled propeller flap of inferior cubital artery, and the other 11 cases were repaired by the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery. The sizes of the flaps were from 4.5 cm × 3.5 cm to 18.0 cm × 8.0 cm. Forty-six of the 51 patients got primary healing, and the other five had necrosis of different degrees at the distal edge of the flap (≤1.5 cm×1.0 cm), including 2 cases of the distal based medial antebrachial neurocutaneous flap, 2 cases of the perforator pedicled propeller flap of inferior cubital artery and 1 case of the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery who were healed after dressing change. The patients were followed up for 3 to 60 months after the operation, with a mean of 12 months, the flaps in the recipient sites survived well, at the same time, the color and elasticity of the flaps were close to normal, and the two-point discrimination was 4-9 mm without bloated appearance. The elbow joint of the affected limb was stable and with good movement. No obvious deformity was observed, and the functional recovery was excellent. The incision of the donor site healed well and the scar was easily accepted. Self-evaluation: 39 patients were satisfied and 12 were general. Elbow joint function evaluation: excellent in 15 cases and good in 36 cases. Comprehensive evaluation: excellent in 17 cases, good in 30 cases, general in 4 cases, that meant the excellent and good ratio reached to 92%(47/51).Conclusion:The three kinds of pedicled perforator flaps have constant perforating vessels, abundant blood supply and simple operation. They can be used to repair soft tissue defects around the elbow joint while good clinical result can be obtained. The distal based medial antebrachial neurocutaneous flap is focused on the anterior and ulnar sides of the elbow joint, the perforator pedicled propeller flap of inferior cubital artery is focused on the elbow fossa, and the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery is focused on the posterior and radial sides of the elbow joint.
