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This allows restoration of both form and function simultaneously. Free tissue transfer also tends to produce donor sites that can be closed primarily. Another advantage of free flaps is the potential for functional muscle transfer to restore elbow flexion. The use of free tissue does, however, relies on the availability of recipient vessels. In our experience, revascularization of the flap is best done end-to-end to the radial or ulnar artery by turning their proximal ends up or end-to-side to the brachial artery if vessels distant to the joint are not available. Choice of flap is dictated by size BKM120 order of defect, donor site morbidity, and tissue defect. In the past, we have used a rectus abdominis flap to cover a large elbow defect. More recently, Chui et al. reported the use of the anterolateral thigh (ALT) flap in 5 patients from our center [24]. Defects ranging from 36?cm2 to 450?cm2 were resurfaced with either fasciocutaneous or musculocutaneous NU7441 in vitro ALT flaps, with no flap failures or major complications. All patients had reasonable and functional return of active elbow motion. The advantages of the ALT flap are large amounts available and the potential to include the vastus lateralis in the flap. The motor nerve to the vastus lateralis can be used as a vascularised nerve graft if required, and fascia lata grafts can be harvested at the time of flap elevation. In addition, the fasciocutaneous flap allows for gliding of tendons and secondary surgery if needed. We recognize that the above study is limited by its small sample size. However, each case was carefully considered and dissected based on each individual's requirements. In addition to this, our case series and algorithm Oxygenase have been limited to the need for soft tissue reconstruction of the elbow. Patients who require bone or joint reconstruction would need additional considerations besides those mentioned above. In our center, the presence of microsurgical expertise in combination with the versatility of free tissue transfer has now made it our first choice for soft tissue coverage in the reconstruction of large elbow defects. Drawing from our clinical experience and literature review, we have created a clinical algorithm (Figure 7) for soft tissue coverage of the elbow that is based on size and location of the defect which has helped our center make safe yet rehabilitation-optimized flap choices. When critical structures are exposed, soft tissue coverage is paramount and the choice of flap is simply mandated by size. Smaller defects, determined from our experience as those