Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Soft-tissue coverage for wound complications following total elbow arthroplasty

  • Macken, Arno A. (Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School) ;
  • Lans, Jonathan (Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School) ;
  • Miyamura, Satoshi (Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School) ;
  • Eberlin, Kyle R. (Plastic, Reconstructive and Hand Surgery, Massachusetts General Hospital, Harvard Medical School) ;
  • Chen, Neal C. (Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School)
  • Received : 2021.06.30
  • Accepted : 2021.08.20
  • Published : 2021.12.01
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Abstract

Background: In patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA. Methods: We retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months-14.7 years). Results: Seven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation. Conclusions: This study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.

Keywords

Acknowledgement

The abstract of this work was presented as a poster at the American Association for Hand Surgery Annual Meeting in January 2020.

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