A Case of Reconstruction for Skin, Brachial Artery, Elbow Flexor Muscle, and Median Nerve Defects Following Wide Resection of a Malignant Soft Tissue Tumor in the Anterior Elbow

Abstract

　Background: A patient underwent extensive resection of a malignant soft-tissue tumor located anterior to the elbow, resulting in extensive loss of skin, the brachial artery, the median nerve, and the elbow flexor muscle. Functional reconstruction was performed using a combination of plastic and orthopedic surgical techniques, with excellent outcomes.
　Case Report: A 59-year-old man underwent wide resection of a high-grade soft tissue sarcoma involving the brachial artery, median nerve, and elbow flexor muscle, resulting in extensive soft tissue loss. First-stage reconstruction included vascular reconstruction using a great saphenous vein graft, elbow flexion reconstruction using the Zancolli method, and soft tissue coverage with a latissimus dorsi musculocutaneous flap.
　At 3 months postoperatively, second-stage reconstruction included tendon transfers to restore flexion of the thumb to middle finger and sensory reconstruction using very distal sensory nerve transfer with the dorsal radial sensory branch.
　At 1 year, elbow flexion reached manual muscle test 5. Finger flexion and protective sensation were restored, and daily function improved significantly. The patient reported high satisfaction.
　Conclusion: The combination of plastic and orthopedic techniques achieved successful functional restoration. This case supports the utility of an orthoplastic approach in complex oncologic reconstruction.