Annales de chirurgie plastique et esthétique
-
Ann Chir Plast Esthet · Jun 1994
[Severe injuries of the elbow: emergency coverage and transient revascularization. Apropos of 13 cases over a 3-year period].
Large open elbow fractures with extensive soft-tissue loss must be treated as an emergency. Vessels and nerves are often alvulsed. One stage reconstruction is very challenging. ⋯ Between the donor site and the recipient site, the muscular part of the latissimus dorsi flap is placed in an arm counterincision. It ensures closure of the elbow joint. Early progressive range of movement exercises can be performed.
-
An anatomical study which was carried out on 44 upper limbs of fresh cadavers has enabled us to describe a new flap based on the superior perforating branch of the anterior interosseous artery: "the anterior interosseous flap". The anterior interosseous artery participates in the vascularization of the dorsal aspect of the distal two-third of the forearm by providing two perforating branches, "the superior and the inferior perforating branches". The superior perforating branch of the anterior interosseous artery, pedicle of the flap, perforates the interosseous membrane 10 +/- 2 cm above the radio-carpal joint and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. ⋯ The surgical procedure of the retrograde island flap consists in raising the cutaneous or compound flap based on the superior perforating branch, division of the interosseous membrane and ligature of the anterior interosseous trunk proximally. The flap is vascularized by a retrograde blood flow through the dorsal (or volar or both) vascular network of the wrist. Theoretically, the most distal point of rotation of the flap is located at the level of the luno-capitate joint and the pedicle is long enough to allow the most distal point of the flap to reach the DIP joint of the finger.(ABSTRACT TRUNCATED AT 400 WORDS)