A 40-year-old male was a front seat passenger in a car involved in a road traffic accident. He sustained fractures of the left 1st to 6th ribs, a left sided pneumothorax, pneumomediastinum, left scapula fracture, dislocation of the left little finger PIPJ as well as a crush injury of the left elbow with open fracture of the left humerus and proximal ulna. A chest tube was inserted and the little finger reduced. The elbow wound underwent debridement followed by external fixation and negative pressure dressing. Internal fixation of the humerus and ulna and soft tissue coverage with a free ALT flap were performed 13 days following injury. Nineteen months postoperatively active elbow motion was 115° (range, 15° to 130°) ().
Case 4. A 35-year-old male sustained loss of anterior elbow soft tissue in a workplace accident. This exposed underlying tendons, vessels, and nerves. The large defect was resurfaced with a free ALT fasciocutaneous flap with a cuff of vastus lateralis muscle (). In 12 months postoperatively, the patient has excellent contour and 110° ROM.