General Principles
Ideally 4cm proximal to elbow joint
- This amount of length allows for an elbow lock mechanism prostheses to be fit
- This stabilises the joint in the any position from full extension to full flexion to allow for better function
At or above pec major leads to no rotation
- Becomes essentially a shoulder disarticulation
- Maintains humeral head though which maintains shoulder contour — more cosmetically pleasing
Technique Considerations
Supracondylar Area
- Equal anterior & posterior flaps each of length that is half the diameter of arm at that level
- Doubly ligate & divide brachial artery just proximal to level
- Transect median/ulnar/radial nerves higher so ends retract well proximal to end of stump
- Divide anterior muscles approx 1.3cm distal to level so retract to level
- Free triceps from olecranon preserving it as a long flap
- Incise periosteum circumferentially at least 4cm proximal to joint
- Divide bone & round ends with rasp
- Bring triceps over bone end & suture tendon to fascia over anterior muscles
- Insert drain deep to fascia, close skin with interrupted nonabsorbable sutures
Proximal to Supracondylar Area
- As per supracondylar area but divide triceps 3.8-5cm distal to level, again suture to anterior fascia
Author Contributions
Page written by Dr James Drummond