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Forearm Vessel Turnover for Free Flap Elbow Reconstruction: A Case Series
Brooks J Knighton, MD
1, Benjamin Vanderkwaak, BS
1, Joseph Amadeo Lewcun, MD
1, Megan R Newsom, MD
1, Alvin Wong, MD
2; Ja Hea Gu, MD
1(1)Virginia Commonwealth University, Richmond, VA, (2)Stony Brook University, Stony Brook, NY
Background: Soft tissue defects of the elbow requiring free tissue coverage can be caused by a number of etiologies including trauma, oncologic resections, and orthopedic hardware exposure. Standard microsurgical practice favors the use of recipient vessels within or adjacent to the zone of injury. However, this may not be feasible in cases where local vessels are compromised. In such scenarios, distal forearm vessels can serve as alternative recipient sites. Additionally, if performed with concomitant procedures, their use may reduce additional dissection and associated morbidity. To that end, we present a technique utilizing forearm vessels ligated at the wrist and rotated proximally to serve as recipient vessels for free flap reconstruction of the elbow.
Materials & Methods:From March 2023 through April 2024, four patients underwent coverage of elbow defects using free flaps anastomosed to forearm vessels ligated at the wrist and turned over to serve as recipient sites for arterial anastomosis. Pre-, intra-, and post-operative data were compiled and analyzed.
ResultsAll patients underwent successful end-to-end anastomoses with durable coverage. Three of four flaps were anterolateral thigh flaps. The other was a vastus lateralis with free fibula flow-through flap to replace a portion of humerus in addition to providing elbow coverage. The ulnar artery was used in three of the four anastomoses. A single patient experienced post-operative hematoma without flap compromise. Patients were followed for 8-16 months with no additional postoperative complications, including partial or total flap loss. Two underwent secondary flap debulking without compromise.
Conclusion:Our data suggests that turnover of vessels at the wrist offers a safe option for reconstruction of elbow defects while also maximizing pedicle length, providing size match for end-to-end anastomosis, and preserving vessels proximal to the zone of injury.
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