Poster
# 111
Poster |
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6th Internet World Congress for Biomedical Sciences |
Alejandro Nogueira(1), MŞ Jesús Martínez González(2), Olatz Alcelay(3), Francisco Iglesias(4)
(1)(2)(3)(4)Hospital Central de Asturias - Oviedo. Spain
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[Orthopedics & Traumatology] |
[Plastic Surgery] |
Severe traumatism of the elbow frecuently involve nervous structures, specially ulnar nerve. Reconstruction of this anatomic area is possible due to fasciocutaneous flap based in anastomosis which are produced at the epicondyle and epitroclea level betwwen recurrent antebrachial vessels and cutaneous-septocutaneous arteries in the arm. Lateral arm flap is based in colateral radial posterior artery, which divides at the epicondyle area in anterior and posterior branches. Anterior division runs over the brachioradialis muscle for 15 cm and is the pedicle of the lateral forearm flap.
The authors present a case of 11 year-old, female, that suffers a serious injury at the medial side of the elbow with a lawnmover and is reconstructed with this flap.(2).
An 11 year-old, girl, suffers a lawnmover injury at the medial side of her right elbow. She presents a skin defect of 12x10cm from medial epicondyle to elbow flexion crease, and a defect of ulnar nerve of 8 cm. Epitroclear muscles and capsulo-ligamentous structures are destroyed.
As an emergency procedure the wound was debrided, ulnar nerve transposed anteriorly and buried in muscular masses. 48 hours later the patient was taken to the operating room for second look and reconstruction. At this time a lateral forearm flap it´s tailored in a pedicle fashion with 12 cm lenth. Ulnar nerve gap is saved with sural nerve 5 cm graft, and all the neural portion, epitroclea and joint are covered by the flap.
Figure 1: Defect after debridement and ulnar nerve gap.
Figure 2: Design of the flap.
Figure 3 and 4: Flap tailored and transposed to elbow medial defect.
Figure 5: Sural nerve in ulnar nerve gap.
Figure 6: Defect and nerve are covered by the flap.
Figure 7: Inmediately post-op.
1 year later nerve graft is working properly at the hand and flexion-extension of the elbow is completely.
The options of elbow coverage with pedicled flaps are numerous, given the rich collateral circulation of the arm and forearm. Lateral forearm flap is based in an anterior division of the posterior radial colateral artery at the epicondyle, that runs over the brachioradialis muscle vascularizing the forearm skin for 15 cm in an adult. We chose it in this case for its easy design, length, hight vascularitation and low morbidity (1), ( 3), (4).
This flap is an excellent option for elbow and ulnar nerve coverage. Microvascularized flaps in children are sometimes uncertain because spasm of vessels is frecuent, furtheremore, free flaps cause hight morbidity.
On the other hand, evolution of nervous regeneration in children is much better than in adults.
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[Orthopedics & Traumatology] |
[Plastic Surgery] |
