Soft-tissue coverage of the elbow: An outcome analysis and reconstructive algorithm

BACKGROUND: Soft-tissue defects surrounding the elbow can be a challenging problem for the reconstructive surgeon. Multiple reconstructive options are available, but there are few published outcome studies. The authors performed an outcome analysis of soft-tissue coverage for elbow defects to determine the benefits and limitations of various reconstructive options in this problematic area. METHODS: A retrospective review was performed of all elbow defects requiring flap coverage from 1988 to 2005. Patient demographics, defect characteristics, type of flaps used, complications, and long-term outcomes were analyzed. The t test was used for statistical comparison. RESULTS: A total of 99 flaps were performed in 96 patients. Forty-seven percent of the defects were secondary to trauma. Sixty-six percent of the flaps used were pedicled flaps and 19 percent were free flaps. The most common pedicled flap used was the radial forearm flap, whereas the most commonly used free flap was the latissimus dorsi muscle flap. Reconstructive failures occurred in 10 percent of patients; these 10 patients required a second flap for limb salvage. The pedicled latissimus dorsi muscle flap had the highest complication rate (57 percent), with distal necrosis being the most frequent complication. The pedicled latissimus dorsi flap was associated with a higher complication rate when compared with the radial forearm flap (p = 0.01). CONCLUSIONS: The pedicled latissimus was associated with a high rate of distal necrosis when it was used to cover defects distal to the olecranon. The authors recommend the use of the radial forearm flap or a free flap for soft-tissue coverage of defects lying over the proximal ulna.