Distant Pedicled Flaps for Elbow Coverage- a Systematic Review

Year 2020, Volume: 3 Issue: 2, 72 - 80, 10.07.2020

Ömer Berköz H. Utkan Aydın

Abstract

Coverage of elbow defects can be challenging for reconstructive surgeons. The intended reconstruction not only has to cover and protect the underlying structures but also allow for smooth functioning of the joint. Even in the era of microsurgery, certain defects are not amenable to reconstruction with regional flaps or free flaps. Pedicled flaps from the abdomen play a critical role in such cases to salvage the elbow and hence the limb. While there are multiple such flaps mentioned, a systematic review is lacking. This systematic review aims to look at all the pedicled flaps from the abdomen to the elbow reported in the literature. After an extensive search of multiple databases, 159 articles were obtained, of which 31 were selected. The flaps reported in the selected articles were grouped into muscle/ musculocutaneous or skin/fasciocutaneous flaps. While the latissimus dorsi appeared to be the most utilized flap overall to cover the defect in the elbow region, paraumbilical perforator-based flaps were the most common among the fasciocutaneous flaps. This review highlights the commonly used flaps, and discusses the advantages and disadvantages of each. In view of the considerable overlapping names of various fasciocutaneous flaps, we offer a nomenclature for better communication and understanding.

Keywords

Elbow, Reconstruction, Pedicled flap

Dirsek Bölgesi Defektlerinin Onarımında Uzak Pediküllü Flepler: Sistematik Derleme

Abstract

Dirsek bölgesi defektlerinin kapatılması rekonstrüktif cerrahlar için kendine özgü çeşitli güçlükler içerir. Amaçlanan rekonstrüksiyon sadece allta yatan yapıları örterek korumakla kalmamalı, aynı zamanda dirsek ekleminin sorunsuz hareketine de izin vermelidir. Mikrocerrahi cağında bile bazı defektlerin bölgesel ya da serbest fleplerle onarımı olanaklı olmayabilir. Bu tip olgularda abdomenden hazırlanan pediküllü flepler dirseğin ve dolayısı ile ve ekstremitenin kurtarılmasında çok önemli bir rol oynarlar. Bu amaçla pek cok flep tanımlanmış olsa da bu konu üzerine yazılmış derlemelerin sayısı kısıtlıdır. Bu sistematik derlemenin amacı literatürde dirsek bölgesi defektlerinin onarımı için abdomen bölgesinden hazırlanan flepleri konu alan çalışmaları gözden geçirmektir. Bu amaçla çesitli veri bankalarının kapsamlı taraması sonucu bulunan 159 makalenin 31 tanesi seçildi. Seçilen makalelerde bahsi geçen flepler kas / muskulokutan ya da cilt/ fasyokutan flepler olarak sınıflandırıldı. Genel olarak, latissimus dorsi flebi dirsek bölgesi fleplerinin kapatılması için kullanılan en yaygın flep olarak ortaya çıksa da, paraumblikal perforatörlere baze flepler en sık kullanılan fasyokütan flepler idi. Bu derleme, en sık kullanılan flepleri ortaya koyup bunların kullanımı ile ilgili avantaj ve dezavantajları tartışmaktadır. Farklı fasyokütan flepleri tanımlamak için kullanılan terimler arasında karışıklığa yol açacak derecede bir örtüşme olduğundan, bu fleplerin daha iyi anlaşılması ve daha iyi iletişim için yeni bir tanımlama şablonu da sunulmuştur.

Keywords

Dirsek, Rekonstrüksiyon, pediküllü flep

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