The reverse lateral arm adipofascial flap for elbow coverage.

The reverse lateral arm adipofascial flap covered immediately with a skin graft has been used successfully for reconstruction of a cubital fossa defect (caused by avulsion injury) and an exposed olecranon (resulting from recurrent bursitis) in 2 patients. The flap is nourished by the septal perforators of the posterior radial collateral artery, which in turn obtains its blood supply from the interosseous recurrent artery. The distal vascular pedicle should contain a sufficient amount of subcutaneous fat and its underlying fascia to enhance the arterial input and the venous drainage of the flap. The primary benefit of this technique is that the thickness of the flap can be tailored to fit into the defect, and the donor site can be closed primarily without tension. The advantages include satisfactory cosmetic results, a rapid one-stage procedure, no sacrifice of the main artery or local muscle, and avoidance of any long-term immobilization of the involved elbow joint.