The use of the anterolateral thigh vascular free flap in complex open elbow fractures after major trauma - An illustrated report of an interesting case

Abstract

Major trauma may result in severe open elbow fractures with significant soft tissue injury and skin loss. Reconstruction of those defects can be complicated and inadequate cover can result in severely limited functional outcome.The free anterolateral thigh flap (ALT) is one of the ways to reconstruct those defects. Its utilisation in severe complex open elbow fractures is recently being increased due to its advantages. The purpose of this article is to present an interesting case where the ALT flap was used with success in a challenging situation of a severe elbow bony, ligamentous and soft tissue injury.Our case has demonstrated that the ALT flap presents an effective method in treating successfully severe open elbow fractures, and its advantages include 1)large amount of available skin and subcutaneous tissue for coverage of the elbow joint without creating strictures, 2)potential of using the vascularised vastus lateralis muscle to minimise the residual dead space in order to prevent infection and as a vascular bed for nerve grafting and 3) the ability to harvest fascia lata grafts and use them to reconstruct ligamentous and tendinous injuries. We recommend the use of the vascularised ALT flap when treating severe open elbow fractures.

Keywords

• Elbow
• Open fractures
• Free flaps
• Ligament reconstruction