Posterior ulnar recurrent artery perforator flap for elbow reconstruction: a forearm-based propeller flap

Soft tissue reconstruction around the elbow is challenging due to the need for durable yet pliable coverage that preserves joint mobility and function. We present the case of a 56-year-old gentleman with a chronic elbow wound secondary to osteomyelitis. Following debridement, the defect was reconstructed using a posterior ulnar recurrent artery perforator (PURAP) flap designed in a propeller style. Unlike previous reports that have described PURAP flaps based on arm perforators, this case uniquely utilised perforators arising from the forearm. This forearm-based approach offers several advantages, including reduced donor-site morbidity, and avoidance of dissection near the ulnar nerve. This case highlights the versatility and safety of the forearm-based PURAP flap for elbow reconstruction. <i>Level of evidence</i>: Level 5.