A case of infection and severe soft tissue loss of the elbow. Planning surgical treatment in compliance with good clinical-care practices and medico-legal implications.

A case of infection and severe soft tissue loss of the elbow. Planning surgical treatment in compliance with good clinical-care practices and medico-legal implications.

Authors

  • Federico Amadei hand surgery and peripheral nerve center cof lanzo hospital
  • Maurilio Cosimo Bruno Consultant of Hand Surgery and Reconstructive Microsurgery Villa Stuart Clinic Rome, Italy
  • Carlo Romano' Orthopaedic Surgeon at San Gaudenzio Clinic Novara, Italy
  • Giuseppe Basile Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy

Abstract

Soft tissue loss around  the elbow, with tendons, nerves and bone exposure,  represents a challenging condition, often requiring a complex and accurate surgical reconstruction. Inadequate repair of soft tissue defects may in fact compromise further reconstructive orthopedic procedures, including  osteosynthesis and joint replacement. A correct reparative sequence of these lesions usually starts with an appropriate debridement and removal of all non-viable and infected tissues, followed by soft tissues management through plastic and reconstructive techniques.
Here we present a case report, showing a successful surgical solution, using a local muscular flap. The results are discussed in light of their functional and medico-legal implications, considering the frequent occurrence of partial functional recovery, the disabling impact on social and work activities and the aesthetic sequelae of these lesions, even in spite of a successful treatment.

Author Biographies

Maurilio Cosimo Bruno, Consultant of Hand Surgery and Reconstructive Microsurgery Villa Stuart Clinic Rome, Italy

Consultant of Hand Surgery and Reconstructive Microsurgery Villa Stuart Clinic Rome, Italy

Carlo Romano', Orthopaedic Surgeon at San Gaudenzio Clinic Novara, Italy

Orthopaedic Surgeon at San Gaudenzio Clinic Novara, Italy

Giuseppe Basile, Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy

Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy

References

Sherman R. Soft-tissue coverage for the elbow. Hand clinics. 1997 May;13(2).

Bishop AT. Soft tissue loss about the elbow. Selecting optimal coverage. Hand clinics. 1994 Aug;10(3):531–542.

Jensen M, Moran SL. Soft tissue coverage of the elbow: a reconstructive algorithm. The Orthopedic clinics of North America. 2008 Apr;39(2):251–264.

Patel KM, Higgins JP. Posterior elbow wounds: soft tissue coverage options and techniques. The Orthopedic clinics of North America. 2013 Jul;44(3):409–417.

Orgill DP, Pribaz JJ, Morris DJ. Local fasciocutaneous flaps for olecranon coverage. Annals of plastic surgery. 1994 Jan;32(1):2

Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003; 50: 90-9.

Panse N, Sahasrabudhe P. Free style perforator based propeller flaps: simple solutions for upper extremity reconstruction. 2014 Indian J Plast Surg 47(1):77–84

Del Bene M.-Amadei F. Microchirurgia e Traumatologia della Mano. Casa Editrice Piccin 2007 – ISBN 978-88-299-1301

Park JJ, Kim JS, Chung JI. Posterior interosseous free flap: various types. Plastic and reconstructive surgery. 1997 Oct;100(5):1186–1197. discussion 1198-1189.

Mordick TG, Britton EN, Brantigan C. Pedicled latissimus dorsi transfer for immediate soft-tissue coverage and elbow flexion. Plastic and reconstructive surgery. 1997 May;99(6):1742–1744.

Rohrich RJ, Ingram AE., Jr. Brachioradialis muscle flap: clinical anatomy and use in soft-tissue reconstruction of the elbow. Annals of plastic surgery. 1995 Jul;35(1):70–76.

Derderian CA, Olivier WAM, Baux G, et al. Microvascular free-tissue transfer for traumatic defects of the upper extremity: a 25-year experience. J Reconstr Microsurg 2003; 19: 455-61.

Leininger BE, Rasmussen TE, Smith DL et al. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma 2006; 61: 1207- 11.

Hallock GG. The utility of both muscle and fascia flaps in severe upper extremity trauma. J Trauma 2002; 53: 61-56

Choudry UH, Moran SL, Li S, Khan S. Soft-tissue coverage of the elbow: an outcome analysis and reconstructive algorithm. Plastic and reconstructive surgery. 2007 May;119(6):1852–1857.

Stevanovic M, Sharpe F, Itamura JM. Treatment of soft tissue problems about the elbow. Clinical orthopaedics and related research. 2000 Jan;(370):127–137.

Basile G., Gallina M., Passeri A., Gaudio R.M., Castelnuovo N., Ferrante P. “Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics”. 2021 - Journal of Orthopaedics and Traumatology DOI: 10.1186/S10195-021-00607-6

Basile G., Passeri A., Bove F., Accetta R., Gaudio R.M., Calori G. M.. Pelvic ring and acetabular fracture: Concepts of traumatological forensic interest. 2021. Injury:https://doi.org/10.1016/j.injury.2021.11.063

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Published

30-06-2022

How to Cite

1.
A case of infection and severe soft tissue loss of the elbow. Planning surgical treatment in compliance with good clinical-care practices and medico-legal implications. Acta Biomed [Internet]. 2022 Jun. 30 [cited 2024 Apr. 25];93(S1):e2022106. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12389

How to Cite

1.
A case of infection and severe soft tissue loss of the elbow. Planning surgical treatment in compliance with good clinical-care practices and medico-legal implications. Acta Biomed [Internet]. 2022 Jun. 30 [cited 2024 Apr. 25];93(S1):e2022106. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12389

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