Two-stage total elbow arthroplasty after reconstruction of a soft tissue defect
The OBJECTIVE of the study was to analyze the results of treatment of patients with severe injuries of the elbow joint, who underwent two-stage reconstruction of soft tissues and total elbow arthroplasty (TEA), to assess of the effectiveness of tactics, early and long-term functional state.METHODS AND MATERIALS. A retrospective analysis of the treatment of 8 patients from 2009 to 2019, who had extensive soft tissue injuries that required complex soft tissue reconstruction and total elbow arthroplasty, was carried out. 6 male and 2 female patients, average age 33.5 years (min. 27, max. 39 years), no concomitant diseases. Injuries in 6 patients were IIIB, in 2 patients - IIIC (classification of R. B. Gustilo and J. T. Anderson (1976). Upon admission as an emergency, all patients underwent primary surgical debridement, then two-stage reconstruction of soft tissues and after wound healing, total elbow arthroplasty.RESULTS. With a favorable course of the wound process on average for (11.6±6.5) days (min 1 day, max 36 days), soft tissue reconstruction was performed: musculocutaneous (thoracodorsal flap) or fascial skin flaps (medial fascial skin flap thighs 3 cases and scapular flap 4). TEA was performed on average (219.1±22.2) days (min. 158 days and max. 308 days) after wound healing with Coonrad-Morrey prostheses (Zimmer, Warsaw, IN, USA). The average follow-up period after arthroplasty was (8.8±2.1) years (min. 8 years, max. 10 years). After surgery, functional results improved: on the DASH scale from (91±6) to (19.5±2.8), and on the MEPS scale from (33.5±3.3) to (80.6±6.5), hand strength from (23.3±3.8) kg to (42.1±3.7) kg and persisted throughout the observation period. No infectious complications were noted.CONCLUSION. Severe injuries of the elbow joint area with a defect in bones and soft tissues can be successfully operated with two-stage microsurgical reconstruction of soft tissues and TEA, this tactic allows to obtain a good longterm functional result and does not interfere with revision surgery.