Abstract
Gustilo-Anderson grade IIIB severe open fracture of the olecranon with skin defect require early wound covering to treat the fracture, but wound covering with simple topical flaps or skin grafts is often difficult due to surrounding skin damage and bone exposure. Consequently, it requires some kind of flap reconstruction. We presented 2 cases of treatment for exposed olecranon degloving trauma (Gustilo-Anderson grade IIIB), and discussed the selection of flaps for these complex injuries, based on the points of reflection on the complications. When injured by this type of high-energy trauma, the surgeon should be aware of the following two points. Firstly, the arterial perforator branch to the skin around the wound is torn by shear stress, and secondly, delayed arterial embolism can occur.
Therefore, a flap should be obtained outside the zone of injury. Therefore, for forearm injuries, the flap should be raised from the upper arm, and for upper arm injuries, the flap should be raised from the forearm. A free flap is the choice for extensive injuries from the upper arm to the forearm.
(a) Left elbow skin loss with exposed fractured bone is visualized. The upper arm was primarily exfoliated. (b) The wound defect was covered with a posterior interosseous flap. (c) Two days after reconstructive surgery, the posterior interosseous flap developed ischenia and necrosis. (d) Image of the flap 3 months after the second reconstructive surgery.
