Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

Background Complex elbow injuries with associated nerve, muscle, or joint injury commonlydevelop post-inury stiffness. In order to preserve function, joint congruency, elbow stabilityand durable wound coverage must be achieved in a timely manner.Methods A retrospective review of patients who underwent orthopaedic fixation followedby free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients wereidentified and included in this study.Results We present a series of 5 cases managed with this principle. Soft tissue defects rangedin size from 4×9 cm (36 cm2) to 15×30 cm (450 cm2) and were located either posteriorly(n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nervetransection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11to 42 day). There were no flap failures and no major complications. The mean postoperativeactive elbow motion was 102° (range, 45° to 140°).Conclusions In our small series we have highlighted the safety and utility of using the freeALT flap in complex elbow injuries. The ALT flap has many advantages which include abundantskin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our seriesto obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and,access to fascia lata grafts for reconstruction of the triceps tendon.