Free Flap Salvage in Lower Extremity Reconstruction via Use of Contralateral Lower Extremity Recipient Vessels
نویسندگان
چکیده
Lower extremity trauma is extremely common and accounts for almost 15% of emergency room visits,1 with 492,000 tibia, fibula, and ankle fractures per year in the United States.2 Acute injuries are commonly managed primarily by orthopedic surgeons with fracture fixation or stabilization. In complex fractures involving the lower limb, as in Gustilo grade IIIB or IIIC fractures, limb salvage typically requires the involvement of reconstructive surgeons. Durable soft-tissue reconstruction to support fracturehealing and provide coverage of underlying hardware is critical. Often, soft-tissue deficits in the distal third of the leg require free flap reconstruction, as local and regional flaps are unavailable secondary to the extent of the injury or are too small to span the entire defect.3 Identification of suitable recipient vessels is challenging when the zone of injury is large.4 Similar to pedicled cross-leg flaps, surgeons can consider a free cross-leg flap reconstruction of extremities with an extensive zone of injury and compromise of the regional blood supply.4–6 We present a case where a traditional free latissimus dorsi muscle flap reconstruction was attempted for coverage of a large distal leg defect. However, due to ongoing thrombosis of progressively more proximal vessel anastomoses, the harvested flap was salvaged via the use of the contralateral anterior tibial artery and vein.
منابع مشابه
Reconstruction of the Lower Extremity Using Free Flaps
BACKGROUND The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. METHODS We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremit...
متن کاملReconstruction of the Lower Extremity with Cross-Leg Free Flaps
Lower limb defectsmaybe present due tovarious causes, such as infections, vascular diseases, tumor resections, and crush or avulsion injuries. If a defect in the lower extremity cannot be reconstructed with a skin graft, the choice of defect reconstruction will favor local flaps and free tissue transfers.1–5 In appropriate cases, skin graft and local flaps can be well tolerated by both patients...
متن کاملFree Flap Transfer to Preserve Main Arterial Flow in Early Reconstruction of Open Fracture in the Lower Extremity
The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap. When the dorsalis pedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of vascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally perform end-to-side anastomosis or f...
متن کاملRepair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report
Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would n...
متن کامل