Reconstruction of Complex Zygomatico-Maxillary Defect Using the Free Vascularized Cutaneous Flap and Autogeneous Bone Graft: Case Report

Transposition Lateral Arm Flap for Coverage of the Elbow Defects

PURPOSE: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. MATERIALS AND METHODS: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 cm2. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. RESULTS: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. CONCLUSION: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

Comparação entre os retalhos microcirúrgicos antebraquial e lateral do braço em reconstruções de boca e orofaringe / Comparison between the forearm and lateral arm flaps for microsurgical reconstruction of the oral cavity and oropharynx

Introdução: A reconstrução microcirúrgica de tecidos moles após ressecção de neoplasias de boca e orofaringe tem impacto significativo na qualidade de vida do paciente. Dois retalhos freqüentemente utilizados são o antebraquial e o lateral do braço. Objetivo: Comparar a evolução do leito receptor e da área doadora em pacientes submetidos a um desses dois retalhos. Pacientes e Método: Estudo retrospectivo com análise de 31 pacientes submetidos aos retalhos previamente descritos. Resultados: Houve predomínio do gênero masculino (56%). A idade média foi de 56,5 anos. Vinte e dois pacientes (71%) foram submetidos à reconstrução com retalho lateral do braço. Houve diferença significativa no tempo de uso de sonda naso-enteral (p=0,037) e no tipo de fechamento da área doadora do retalho (p<0,001). Discussão: Os retalhos, apesar de similares, têm indicações distintas em nosso serviço. Consideramos o retalho lateral do braço como primeira escolha para reconstrução de defeitos de tamanho médio de tecidos moles em boca e orofaringe. Conclusão: Consideramos que os retalhos antebraquial e lateral do braço são seguros e adequados para reconstrução de boca e orofaringe.

Introduction: the microsurgical reconstruction of soft tissues after ablative surgery of oral cavity/oropharynx neoplasms impacts on the patients´ quality of life. Two frequently used options are the forearm and the lateral arm flaps. Objective: to compare the evolution of the receptor and donor sites. Patients and Methods: retrospective study of 31 patients submitted to one of the previously mentioned flaps. Results: Most patients were male (56%). The mean age was 56.5 years old. Twenty-two patients (71%) underwent the reconstruction using the lateral arm flap. There was a statistically significant difference in the duration of enteral tube use (p=0.037) and the closure of the donor area (p<0.001). Discussion: although similar, the flaps have distinct indications in our service. We consider the lateral arm flap as the first choice in medium sized soft tissue defects of the oral cavity/oropharynx region. Conclusion: We consider both flaps to be reliable and adequate for oral cavity/oropharynx reconstruction.