Using of the Reverse Lateral Arm Flap for Elbow Soft Tissue Defects after Tumor Ablation ── Case Report and Literature Review

使用反轉外上臂皮瓣做為手肘腫瘤切除後重建－病例報告及文獻回顧

黃仁穩(Ren-Wen Huang) ； 許聰政(Chung-Chen Hsu) ； Charles Yuen Yung Loh ； 林志鴻(Chih-Hung Lin) ； 林承弘(Cheng-Hung Lin)

《臺灣整形外科醫學會雜誌》 25卷4期 (2016/12) Pp. 330-338

摘要

Background: Proper planning when reconstructing an elbow defect is key to avoid secondary contracture and range of motion limitation. Reconstructive options should be easy to perform yet provide an excellent outcome in this hinge joint. There have been few descriptions in the literature that establish the routine use of the reverse lateral arm flap for soft tissue defects post oncological resection. Cancerous lesions in this area necessitate wide excision margins and hence a large wound is created that cannot be closed primary. We provide a review regarding the use of the reverse lateral arm flap, demonstrating its feasibility and reliability as flap for cancer reconstruction in the elbow region. Aim and objectives: We present using reverse lateral arm flap for elbow reconstruction after tumor ablation. Patients and Methods: We demonstrate its feasibility using two cases of soft tissue malignant tumors on the elbow. One case was a sarcoma and the other was a melanoma that were resected with large excision margins and reconstructed with reverse lateral arm flaps. Results: Both cases had good wound healing and acceptable range of motion post operatively. No wound infection or partial flap necrosis occurred. Conclusions: Elbow reconstruction post tumor resection with isolated soft tissue defects can be achieved with a local pedicled flap. The reverse lateral arm flap is a reliable flap with closest proximity to the site of resection, hence making it a convenient, easy to perform flap with excellent outcomes.

關鍵字

reverse lateral arm flap ； elbow reconstruction ； tumor ablation ； pedicled flap

並列摘要

背 景：重建手肘缺損需注意避免次發性疤痕孿縮所造成的活動受限，針對手肘惡性腫瘤的病人，由於需做廣泛切除以達到安全距離，傷口常常無法直接關閉，須以皮瓣重建。本篇病例報告及文獻回顧提供反轉外上臂皮瓣做為手肘重建的應用及討論。目的及目標：此篇病例報告討論使用反轉外上臂皮瓣做為手肘腫瘤切除後重建。材料及方法：此篇報告闡述使用反轉外上臂皮瓣的適應症並比較文獻中使用各種不同局部皮瓣重建手肘缺損。此篇報告呈現兩個手肘軟組織惡性腫瘤病例，其一為肉瘤，另一為黑色素瘤。結 果：兩個病例傷口皆癒合良好，重建後關節活動都在可接受範圍，術後無傷口感染且皮瓣無局部壞死，文中並描繪出手肘重建可能之局部皮瓣並討論比較之。結 論：手肘腫瘤切除後可使用局部皮瓣重建，反轉外上臂皮瓣針對此一缺損的重建是一可靠，術式簡單，且重建結果良好的皮瓣。