Cubital fossa defect- our reconstructive experience with pedicle flaps

Abstract

Introduction: Cubital fossa wounds can be complicated by the non-availability of reliable, well-vascularized donor tissue. Closure with pliable and readily available donor tissue for cubital defect and early mobilization of the elbow joint is essential for better results. The authors did this study to see how best the results of cubital fossa defect cover can be achieved by pedicle flaps in a single stage without compromising the donor areas.

Material and method: Patients having deep elbow wounds in which vital structures were lying exposed in the cubital region were included in this study. The patients were assessed for the availability of tissue for cover, reliability of flaps, flap pliability, the functional outcome of the elbow and donor site morbidity.

Results: A total of 17 cases of cubital region defects are presented wherein closure of the wound by means of primary closure was not possible. Out of these, eight were covered with Pedicled Thoracodorsal Artery Perforator (TDAP) flaps, five with Pedicled split Latissimus Dorsi Muscle (SLDM) flaps and four with reversed lateral arm flaps (RLA). Post-operatively all the flaps were healthy, patients attained a good range of elbow joint movements with no clinically evident morbidity of the donor site.

Conclusion: Cubital fossa defect coverage needs dedicated planning to obtain a sturdy tissue for cover. In the presence of local tissue damage or scarring, we have looked elsewhere to bring pliable and well-vascularized tissue which is reliable. The flaps we used have allowed single-stage reconstruction and early mobilization of the elbow joint with good functional recovery.

Keywords: Cubital fossa defect; Reverse lateral arm flap; Thoracodorsal artery perforator flap.

Fig. 1

Flowchart for Preoperative Planning of various flaps in a patient with deep cubital fossa defect.

Fig. 2

A 9-year-old girl with post-burn contracture, neck, right elbow and left hand. a. Right elbow burn contracture, b. Contracture release and elbow defect, c. Defect covered by Reverse Lateral Arm (RLA) flap with healed donor site, d. Anterior view after 8 months.

Fig. 3

A case of 43-year male, sustained injury to left elbow due to accidental fall from a tree. a. An ulnar view of Left elbow defect with repaired brachial artery by GSV (Great Saphenous Vein) interposition graft (yellow arrow), b. Marking of TDAP flap, c. Elevated TDAP flap on two perforators (Blue arrows), d. Post-operative, flap cover of the elbow defect. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

A 41-year female with a history of fall from a height with fractured radius & ulna with compartment syndrome left forearm. a. She underwent exploration fasciotomy cubital fossa and forearm, and repair of the brachial and radial artery with interposition GSV (Blue Arrow). b Split Latissimus dorsi muscle (blue star) was utilized to cover the cubital fossa and mid-forearm. c. GSV covered with Split LD muscle flap and skin graft. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)