The anconeus muscle flap: its anatomy and clinical application.

The arterial anatomy, coverage area, and potential donor site morbidity of the anconeus muscle flap are described. Using 17 cadaveric upper extremities, we investigated the muscle's arterial anatomy in 12 specimens and defined the coverage area of the anconeus flap in 5 specimens. We also reviewed the records of 9 patients who underwent a pedicle anconeus muscle flap for elbow coverage to assess clinical results of the procedure. The anconeus muscle is supplied from 3 arterial pedicles: the recurrent posterior interosseus artery, the medial collateral artery, and the posterior branch of the radial collateral artery. The recurrent posterior interosseus artery and the medial collateral artery were present in all dissected cadavers and consistently anastomosed with each other underneath the anconeus muscle. By harvesting the muscle on the medial collateral artery, the anconeus muscle flap can be expected to cover a 7.3 cm2 defect over the radiocapitellar joint, a 6.1 cm2 defect over the distal triceps tendon, and a 7.2 cm2 defect over the olecranon. In this series, none of the patients experienced loss of elbow motion, stability, or extension strength. The results of this study indicate that the anconeus can be harvested with minimal risk of morbidity and provides effective coverage for soft tissue defects of the elbow.

Ankle arthrodesis with an anterior tension plate.

The incidence of complications associated with arthrodesis of the ankle has remained high, especially in wound complications and infections. A new method to achieve arthrodesis of the ankle that utilizes an anterior surgical approach and an anterior tension plate was assessed in 17 patients. This method transforms the potentially deforming force of the tendoachilles into a compressive and corrective force and facilitates realignment of the ankle in all planes. Also, dissection and subperiosteal elevation is minimized while soft tissue coverage of the hardware is maximized. Whereas the predominant preoperative diagnosis was posttraumatic degenerative joint disease, others included failed ankle arthroplasty, failed arthrodesis, and a fixed equinus deformity. A solid arthrodesis was achieved in 82% of the patients. Although complications occurred and two patients required reoperations, there were no problems with respect to wound healing or infection, which is a marked contrast to other series. This technique is recommended as a simple, safe, and effective method to achieve an arthrodesis of the ankle joint.