Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius. The patient has sustained a 5.5 cm epiphyseal radial defect with an associated 20 × 15 cm overlying tissue defect after serial debridement. In review of the literature, only one nontraumatic case using a combined free flap and radial head prosthesis for proximal forearm defect to restore joint function has been reported. We suggest that, for proximal forearm fractures, this technique can be used to restore elbow joint function in limb salvage.

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Combined composite osteofasciocutaneous fibular free flap and radial head arthroplasty for reconstruction of the elbow joint

Microsurgery ◽

10.1002/micr.22228 ◽

2014 ◽

Vol 34 (6) ◽

pp. 475-480 ◽

Cited By ~ 6

Author(s):

Nick A. van Alphen ◽

Matthew T. Houdek ◽

Scott S. Steinmann ◽

Steven L. Moran

Keyword(s):

Free Flap ◽

Radial Head ◽

Elbow Joint ◽

Radial Head Arthroplasty ◽

Fibular Free Flap

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The proximal fibular free flap - an ideal material for reconstructing distal radius defect after Giant tumor cell resection. A case report

Tạp chí Nghiên cứu Y học ◽

10.52852/tcncyh.v148i12.786 ◽

2021 ◽

Vol 148 (12) ◽

pp. 96-101

Author(s):

Duong Manh Chien ◽

Hoang Tuan Anh ◽

Nguyen Tran Quang Sang ◽

Phan Van Tan ◽

Nguyen Huu Trong ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Free Flap ◽

Wrist Joint ◽

Cell Tumor ◽

Joint Function ◽

Giant Cell Tumors ◽

Tumor Excision ◽

Fibular Free Flap

Giant cell tumors (GCT) of the distal end of radius are relatively common tumors, representing approximately 5% of all primary bone tumors. It is the third most common location for GCT following distal femur and proximal tibia. In general, treatment includes thorough tumor excision, reconstruction of the defect, and wrist joint rehabilitation. The proximal fibular free flap is an ideal material for distal radius reconstruction after giant cell tumor excision. We present a case of a 57-year-old female, admitted to the hospital due to painful and limited proper wrist movement. Based on X-ray and Magnetic resonance imaging (MRI) images and histopathology findings, the patient was diagnosed with a stage 3 giant cell tumor of the distal radius. The patient underwent a one-step surgery of tumor excision and distal radius reconstruction by a vascularized proximal fibular free flap. 2 years follow-up post-surgery showed that the patient had no pain of the wrist, improved wrist joint function, no sign of recurrence, and good flap vitality and the knee joint remains normal. In conclusion, the surgery was successful with no further prolonged pain, improvement of the wrist joint function and overall improvement of the patient quality of life.

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Extracorporeal Reconstruction of the Radial Head

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.2399 ◽

2021 ◽

Author(s):

Kow Ren Yi ◽

Zaharul Azri Mustapha Zakaria ◽

Ruben Jaya Kumar ◽

Low Chooi Leng ◽

Khairul Nizam Siron Baharom

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Radial Head Fracture ◽

Removal Rate ◽

Viable Option ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Type Iii ◽

Elbow Function ◽

Radial Head Excision

Radial head fractures are common in adults. The radial head acts as an important stabilizer of the radius, especially during the forearm pronation and supination. Surgical treatment of Mason type III fracture of the radial head includes radial head excision, radial head replacement and open reduction and internal fixation. For patients treated with radial head excision, the radius might migrate proximally, causing complications such as chronic pain at the wrist, forearm, and elbow. On the other hand, radial head arthroplasty is associated with a high revision and removal rate. Hence, openreduction and internal fixation are preferred when feasible. This is technically demanding due to the severe displacement of the radial head fragments and limited surgical space. Mr K, a 30-year-old manual worker sustained a closed right radial head fracture Mason type III after an alleged fall. The radial head was displaced anteriorly. Intra-operatively, the radial headpieces were retrieved and were reconstructed extracorporeal and fixed with a miniplate. The patient subsequently recovered with good function. The new technique of extracorporeal reconstruction of the radial head offers a viable option to the surgeon with similar, or even better, outcomes in terms of elbow function.

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