LOCAL FASCIOCUTANEOUS FLAPS FOR OLECRANON COVERAGE

ln 1989 we began to treat soft-tissue defects around the olecranon pro cess with local fasciocutaneous flaps as our preferred method of treat ment. These soft-tissue defects are complications of bursitis, degener ative joint disease, and burns. They may also result from pressure nec rosis over the olecranon in patients with impaired sensation. Because of the difficulty in treating these wounds a variety of local muscle, musculocutaneous, fasciocutaneous, distant, and free flaps have been d escribed. Fasciocutaneous flaps have the advantage of using regional t issue in a single stage. Fasciocutaneous flaps around the elbow can be categorized as proximally or distally based. Proximally based flaps i nclude the radial and ulnar forearm flaps as well as the posterior int erosseous flap. Distally based flaps are based on upper elbow collater als including the radial collateral artery, the middle collateral arte ry, and the anterior and posterior ulnar recurrent arteries. Eleven fa sciocutaneous flaps were used in 10 patients with a follow-up of 1 to 3 years. All flaps survived and provided primary wound closure. Compli cations included 1 patient with recurrent ulceration after being heale d for 6 months and 1 patient with a transient neurapraxia of the poste rior interosseous nerve that resolved after 2 weeks. These flaps provi de long-term stable coverage of olecranon wounds by using regional tis sue with an acceptable donor site morbidity.