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Posterior Elbow Soft-tissue Reconstruction Using a Flexor Carpi Ulnaris Muscle Turnover Flap
William Slikker, MD1; Christopher Bayne, MD1; Jianjun Ma, MD2; Fraser Leversedge, MD2; Mark Cohen, MD1; Robert Wysocki, MD1
1Rush University, Chicago, IL; 2Orthopedics, Duke University, Durham, NC

Introduction: Management of soft-tissue defects at the elbow remains a challenge. The flexor carpi ulnaris (FCU) flap has been described anatomically as a reliable option for soft-tissue reconstruction of the posterior elbow; however, few studies have reported the outcomes of FCU flaps and the effect of FCU harvest on wrist function. We report the outcomes for patients who have undergone FCU flap for the management of posterior-elbow soft-tissue defects associated with a spectrum of conditions.

Methods: A total of 16 patients who developed a soft-tissue defect on the posterior aspect of the elbow were treated with an FCU flap between the years of 2003 and 2011. Mean follow up was 24 months (range, 6-39 months). Outcomes collected included: elbow and forearm range of motion, wound healing; grip strength; isokinetic dynamometry; visual analogue scores (VAS) for pain; disabilities of the arm, shoulder, and hand (DASH) score; and Mayo Elbow Performance Scores (MEPS). Isokinetic strength in wrist flexion and extension was evaluated using the Biodex II dynamometer (Biodex Medical Systems; [CITY], Shirley, New York). Non-parametric statistical methods were used to analyze the data. The Friedman test was used to make side-to-side comparisons between the injured and uninjured sides.

Results: Index surgical procedures requiring an FCU flap included fracture reduction and internal fixation or total elbow arthroplasty. All wounds healed after the FCU flap surgery with no reoperations. Average VAS was 2.3 in the operative elbow. Average DASH score was 35 and average MEP score was 80. Average elbow range of motion was 11° to 140° and forearm range of motion averaged 70° of pronation and 73° of supination. Operative arm grip strength was 97% of the nonoperative arm. Average wrist flexion peak torque of the operative arm was 87% of the nonoperative arm. Fatigue percentage of wrist flexion/extension was 29% for the nonoperative arm and 7% for the operative arm.

Conclusions: Patients undergoing an FCU flap were found to have little pain as measured by the VAS, good functional outcomes as measured by the DASH and MEP, and largely preserved grip strength and wrist flexion strength. Our results suggest that an FCU muscle flap can be used to effectively cover soft-tissue defects of the posterior elbow with low morbidity to the wrist in terms of pain or disability.

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