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Case Reports
. 2021 Jun 9:10:Doc05.
doi: 10.3205/iprs000155. eCollection 2021.

Multistep reconstruction of a post-traumatic defect in the lower limb with AV loop and free myocutaneous latissimus dorsi flap combined with a perforator monitor skin island after loss of ALT flap

Tobias Summer  1 , Mazen Abou Mrad  2 , Olimpiu Bota  1 , Kevin Bienger  1 , Adrian Dragu  1
Affiliations
Case Reports

Multistep reconstruction of a post-traumatic defect in the lower limb with AV loop and free myocutaneous latissimus dorsi flap combined with a perforator monitor skin island after loss of ALT flap

Tobias Summer et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

Crush injuries of the lower extremity with extensive osseous and soft tissue damage impose a big challenge even for an interdisciplinary reconstructive approach. Multistep reconstruction with negative wound pressure therapy for soft tissue management and external fixation for osseous stability preceding free flap transfer leads to optimized outcome. We report the successful multistep reconstruction of a third-degree open right tibial fracture with extensive soft tissue defect with an arteriovenous loop preceding latissimus dorsi flap coverage with a perforator skin island after loss of an anterior lateral thigh (ALT) flap due to intima damage of the recipient vessels. The described method is a safe reconstructive concept after primary flap loss with persistent extensive tissue damage.

Quetschverletzungen der unteren Extremität mit ausgedehnter Knochen- und Weichteilschädigung stellen selbst für interdisziplinäre rekonstruktive Konzepte eine große Herausforderung dar. Eine sequenzielle Herangehensweise, bestehend aus einem Unterdruckverband gestützten Weichteilmanagement sowie einer Knochenstabilisierung mittels Fixateur externe vor freiem Gewebetransfer, führt zu einem verbessertem Outcome. Wir berichten über die erfolgreiche mehrstufige Rekonstruktion einer rechtsseitigen, drittgradig offenen Tibiafraktur mit ausgedehntem Weichteildefekt mittels einer arteriovenösen Gefäßschleife und folgendem Latissimus dorsi Lappentransfer mit einer perforatorbasierten Hautinsel nach anterior lateral thigh (ALT) Lappenverlust durch Intimaschaden der Anschlussgefäße. Die beschriebene Methode stellt ein sicheres rekonstruktives Konzept nach Lappenverlust mit konsekutiv persistierendem Gewebedefekt dar.

Keywords: latissimus dorsi; lower limb; microsurgery; plastic surgery; reconstruction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Preoperative defect
Figure 2
Figure 2. Defect with AV loop in situ
Figure 3
Figure 3. LD flap plus split skin graft and monitor island
Figure 4
Figure 4. Postoperative result after 2 weeks
Figure 5
Figure 5. Postoperative result after 2 weeks
Figure 6
Figure 6. Postoperative result after 6 months, frontal view
Figure 7
Figure 7. Postoperative result after 6 months, lateral view
Figure 8
Figure 8. Postoperative result after 1.5 years, frontal view
Figure 9
Figure 9. Postoperative result after 1.5 years, lateral view
Figure 10
Figure 10. Posteropative X-rays after 1 year
Figure 11
Figure 11. Intraoperative patient positioning
Figure 12
Figure 12. Harvested LD flap
Figure 13
Figure 13. Venous anastomosis perfomed with 3.0 mm coupler
Figure 14
Figure 14. Arterial anastomosis, single button 8.0 Prolene sutures
Figure 15
Figure 15. LD flap after anastomosis covering the defect
Figure 16
Figure 16. Monitor island with LD flap
See this image and copyright information in PMC

References

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