Free Functional Gracilis Muscle Transfer for Reconstruction during Forearm Reimplantation in a Patient with Deep Venous Thrombosis

Abstract

Background Free muscle transfer is the gold standard procedure for functional upper extremity reconstruction. The gracilis muscle is one of the most commonly used donor muscles due to the reduced morbidity of its harvest.

Case We performed a free gracilis muscle flap transfer for functional reconstruction of a forearm after reimplantation in a 62-year-old man with a known deep venous thrombosis (DVT).

Result Perioperative DVT is a potentially fatal complication due to the risk of pulmonary embolism. There were many risk factors in this case for venous thromboembolism around the time of free flap transfer including the length of the operation, intraoperative position changes, and perioperative suspension of anticoagulants. We divided the operation into two stages to reduce operative times, chose a donor site that did not require intraoperative position changes, placed an indwelling temporary filter in the inferior vena cava preoperatively, and continued administration of anticoagulant intraoperatively.

Conclusion With these measures, we safely and successfully performed free gracilis muscle transfer in a patient with DVT.

Keywords

forearm amputation - functional free muscle transfer - deep venous thrombosis

• References

• 1 Stevanovic M, Sharpe F. Functional free muscle transfer for upper extremity reconstruction. Plast Reconstr Surg 2014; 134 (02) 257e-274e
• 2 Fischer JP, Elliott RM, Kozin SH, Levin LS. Free function muscle transfers for upper extremity reconstruction: a review of indications, techniques, and outcomes. J Hand Surg Am 2013; 38 (12) 2485-2490
• 3 Yang Y, Yang JT, Fu G. , et al. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients. Sci Rep 2016; 6: 22479
• 4 Fan C, Jiang P, Fu L, Cai P, Sun L, Zeng B. Functional reconstruction of traumatic loss of flexors in forearm with gastrocnemius myocutaneous flap transfer. Microsurgery 2008; 28 (01) 71-75
• 5 Kearon C, Akl EA, Comerota AJ. , et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2, Suppl): e419S-e496S
• 6 Klok FA, van Kralingen KW, van Dijk AP. , et al. Quality of life in long-term survivors of acute pulmonary embolism. Chest 2010; 138 (06) 1432-1440
• 7 Ishihara K, Hiromatsu S, Shintani Y, Kanaya K, Mikasa K, Aoyagi S. Clinical outcome of perioperative nonpermanent vena cava filter placement in patients with deep venous thrombosis or blood stasis of the vein. Surg Today 2009; 39 (09) 764-769
• 8 Dhand S, Stulberg SD, Puri L, Karp J, Ryu RK, Lewandowski RJ. The role of potentially retrievable inferior vena cava filters in high-risk patients undergoing joint arthroplasty. J Clin Diagn Res 2015; 9 (12) TC01-TC03
• 9 Ryan E, Kok HK, Lee MJ. Retrievable IVC filters - friend or foe. Surgeon 2017; 15 (02) 104-108
• 10 McNamara I, Sharma A, Prevost T, Parker M. Symptomatic venous thromboembolism following a hip fracture. Acta Orthop 2009; 80 (06) 687-692