Abstract

Background: Post-burn cubital contracture is a common, debilitating complication, especially because the elbow has thin, mobile tissue and nearby neurovascular structures. Surgical reconstruction requires balancing coverage durability, recurrence risk, and early movement. Perforator flaps maintain axial blood supply while providing flexible, pliable tissue.

Objective: To evaluate functional and aesthetic outcomes of the lateral arm perforator flap (LAPF) for reconstruction of post-burn cubital contractures in children.

Patients and Methods: A prospective, single-centre case series was conducted at Assiut University Hospital from June 2023 to May 2025, involving children with mature postburn cubital contracture. They underwent scar excision, stepwise release, then reconstruction using Doppler-mapped perforator-based propeller LAPF. Follow-up occurred at 3, 6, and 12 months, assessing elbow motion and function with the Arabic version of QuickDASH (reported by parents in younger children and self-reported by older children, where feasible), scars with POSAS, and occurrence of complications.

Results: Fifteen children (4–18 years; mean 11 ± 7; 60% male) underwent surgery. The mean post-release defect was 7 ± 2 × 9 ± 3 cm; flap size was 8 ± 2 × 11 ± 3 cm with 120°–180° rotation. Donor sites were closed primarily in 10 patients (66.7%) and grafted in 5 (33.3%). Extension deficit improved from 73.1 ± 26.4° to 9.6 ± 7.4°; flexion–extension arc increased from 78.5 ± 21.9° to 126.8 ± 10.7°; Arabic QuickDASH improved from 51.2 ± 12.6 to 4.5 ± 2.8 at 12 months (all p < 0.001). All flaps survived; venous congestion in 3 patients (20%), with 2 (13.3%) having partial necrosis. No elbow instability or permanent ulnar nerve deficit occurred. POSAS improved to ~3 at 12 months.

Conclusions: LAPF is a reliable regional option for pediatric post-burn cubital contracture reconstruction, providing sustained improvements in elbow motion and patient-reported function with overall acceptable morbidity. A longer follow-up is required to confirm durability through growth.