Reconstruction of fracture associated skin defects on olecranon with antegrade posterior interosseous artery flap

Context: The management of tissue defects of the olecranon after fractures of this region is challenging. Most cases require local or free flaps to obtain both soft-tissue reconstruction and wide range of motion of the elbow joint. Aim: The aim of this study is to describe the results of reconstruction of fracture-associated skin defects on the olecranon with posterior interosseous artery (PIA) flap. Settings and Design: We present our experience of using antegrade PIA flap for soft-tissue coverage of the olecranon region after fracture surgery. Materials and Methods: We retrospectively evaluated 11 cases who underwent reconstruction of the olecranon for soft tissue defect with PIA flap. We evaluated the extent of the soft-tissue defects and the harvested flaps, fracture fixation techniques, complications, patients' demographics, partial or total flap lost, number of perforators, time to reconstruction after injury, esthetic looking of reconstructed area, and donor site coverage. Results: The study included 11 patients (7 males and 4 females). The mean age was 35 years. The mean defect size was 15.4 cm2. The mean flap size was 20 cm2. Plates were used in six cases, tension band wiring in three cases, and external fixators in two cases for fracture fixation. Ten flaps survived completely. There was partial flap necrosis in one flap due to venous congestion. Infection, hematoma, and distal neurological deficits were not observed. Minimal morbidity occurred since the donor site was primarily closed in eight cases and skin graft in three cases. Good cosmetic outcome was achieved in all cases. We detected one perforator in one case, two perforators in five cases, three perforators in four cases, and four perforators in one case. Conclusion: Reconstruction with PIA flap is an effective, useful, and simple surgical technique for soft-tissue coverage on the olecranon region. The procedure involves a single step surgery, low donor site morbidity, and good cosmetic outcomes.