Emergency arterio-venous loop for free-flap defect reconstruction of the lower thigh with a post-irradiated and heavily infected wound

Abstract

Although being a safe and standardised procedure, free-flap reconstruction can be harmful if unpredictable situations occur intraoperatively. The case presented reveals a situation in which an unscheduled interdisciplinary approach allowed to complete our reconstructive aim. An extensive defect at the thigh was planned for reconstruction by means of a free rectus abdominis flap. As the distant part of the flap showed a compromised perfusion during operation and had to be partially discarded, our colleagues from the vascular surgery department created an arterio-venous loop for anastomosis. This allowed a more distant positioning of the flap and ensured a complete defect reconstruction.

Keywords: Arterio-venous loop; Chronic wound; Free-flap; Radiation injury; Thigh.

Figure 1

Defect after extensive debridement of all the necrotic tissue.

Figure 2

Reconstruction with a free rectus abdominis muscle in combination with a perforator‐based monitor skin island.

Figure 3

Arterio‐venous (AV)‐loop using the ipsilateral greater saphenous vein, connected with its distal ending to the femoral artery proximal to the defect.

Figure 4

Result 3 months after free‐flap transfer.