From the Research
Management of complications in the antecubital fossa requires prompt recognition and appropriate intervention based on the specific complication, with a focus on preventing morbidity, mortality, and improving quality of life. The antecubital fossa is a complex anatomical region with multiple vital structures, including nerves and blood vessels, which can be damaged during medical procedures, leading to various complications [ 1 ].
Vascular Complications
For vascular complications like arterial injury, immediate compression, elevation, and vascular surgical consultation are essential [ 2 ]. If a pseudoaneurysm develops, options include ultrasound-guided compression, thrombin injection, or surgical repair.
Nerve Injuries
Nerve injuries may require conservative management with anti-inflammatory medications (ibuprofen 400-600mg three times daily), physical therapy, and neuropathic pain medications (gabapentin starting at 300mg daily and titrating up as needed) [ 3 ]. For more severe nerve injuries, surgical exploration and repair may be necessary.
Infection Management
Infection management includes wound care, elevation, and appropriate antibiotics based on culture results (commonly cephalexin 500mg four times daily for 7-10 days for uncomplicated infections).
Compartment Syndrome
Compartment syndrome, a surgical emergency, requires immediate fasciotomy to prevent permanent tissue damage.
Venous Thrombosis
Venous thrombosis may be treated with anticoagulation (typically low molecular weight heparin followed by oral anticoagulants) and elevation.
Prevention of Complications
Prevention of complications is crucial and includes proper technique during procedures, avoiding multiple puncture attempts, using ultrasound guidance when appropriate, and maintaining sterile technique [ 4 ]. Early recognition of complications through careful monitoring of symptoms like unusual pain, swelling, numbness, or color changes can prevent progression to more serious conditions requiring extensive intervention.
Surgical Options
For soft-tissue defects in the anterior elbow, antecubital fossa perforator flaps can be a viable option, offering satisfactory functional and aesthetic outcomes [ 5 ].
Given the complexity and variability of anatomical structures in the antecubital fossa, a tailored approach to each complication, considering the most recent and highest quality evidence, is essential for optimal management and outcome [ 1 ].