What is the recommended skin incision approach for an olecranon (elbow bone) bursectomy?

Recommended Skin Incision for Olecranon Bursectomy

The recommended skin incision for olecranon bursectomy should be a longitudinal incision over the posterior aspect of the elbow, avoiding direct placement over the olecranon process to reduce wound complications. 1, 2

Anatomical Considerations

• The incision should be placed slightly lateral or medial to the olecranon prominence to avoid creating a scar directly over the pressure point of the elbow 1
• Care must be taken to identify and protect underlying veins and nerves during the dissection 1
• The entire bursa should be identified and removed completely to reduce the risk of recurrence 1

Surgical Technique

• A longitudinal incision provides better exposure and allows for complete visualization of the bursa 1
• After making the skin incision, careful debridement should be performed to identify the entire bursa 1
• The bursa should be removed in its entirety under direct visualization 1
• Contaminated skin should be excised if present, especially in cases of septic bursitis 1

Alternative Approaches

• Endoscopic extrabursal techniques have been described that may reduce wound complications while still allowing complete removal of the bursa 3, 4
• These minimally invasive approaches avoid creating a wound directly over the sensitive olecranon point 3
• The endoscopic approach may be particularly beneficial in patients with high risk of wound complications 3, 4

Post-Surgical Management

• After bursectomy, wound closure should be followed by application of an elastic bandage 1
• A drain may be inserted and typically removed after 2 days 1
• Early functional aftercare without splinting is recommended to maintain range of motion 1

Potential Complications and Considerations

• Wound healing problems occur in approximately 27% of cases following traditional open bursectomy 2
• Recurrence rates of approximately 22% have been reported after surgical resection 2
• The risk of wound complications should be carefully considered when planning the surgical approach 2
• In some cases with prominent olecranon processes, excision of the olecranon process itself (rather than just the bursa) may be considered to prevent recurrence 5

Special Considerations

• For measurement purposes during physical examination, the olecranon process serves as an important landmark when evaluating arm circumference 6
• When planning the incision, consideration should be given to the patient's functional needs and cosmetic concerns 1, 2