Reconstruction of Extensive Soft-Tissue Defects with Concomitant Bone Defects in the Lower Extremity with the Latissimus Dorsi-Serratus Anterior-Rib Free Flap

Wei Tee Sia; Germaine Guiqin Xu; Mark Edward Puhaindran; Bien Keem Tan; Mathew Hern Wang Cheng; Winston Yoon Chong Chew

doi:10.1055/s-0035-1548741

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2015; 31(06): 407-413
DOI: 10.1055/s-0035-1548741

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction of Extensive Soft-Tissue Defects with Concomitant Bone Defects in the Lower Extremity with the Latissimus Dorsi-Serratus Anterior-Rib Free Flap

Wei Tee Sia

¹Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore

,

Germaine Guiqin Xu

²Department of General Surgery, Khoo Teck Puat Hospital, Singapore

,

Mark Edward Puhaindran

³Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore

,

Bien Keem Tan

⁴Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore

,

Mathew Hern Wang Cheng

¹Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore

,

Winston Yoon Chong Chew

¹Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore

› Institutsangaben

Abstract

Background The combined latissimus dorsi-serratus anterior-rib (LD-SA-rib) free flap provides a large soft-tissue flap with a vascularized bone flap through a solitary vascular pedicle in a one-stage reconstruction.

Methods Seven LD-SA-rib free flaps were performed in seven patients to reconstruct concomitant bone and extensive soft-tissue defects in the lower extremity (tibia, five; femur, one; foot, one). The patients were all male, with an average age of 34 years (range, 20–48 years). These defects were secondary to trauma in five patients and posttraumatic osteomyelitis in two patients.

Results All flaps survived and achieved bony union. The average time to bony union was 9.4 months. Bone hypertrophy of at least 20% occurred in all flaps. All patients achieved full weight-bearing ambulation without aid at an average duration of 23.7 months. Two patients developed stress fractures of the rib flap. There was no significant donor site morbidity, except for two patients who had pleural tears during harvesting of the flap.

Conclusion The LD-SA-rib flap provides a large soft-tissue component and a vascularized bone flap for reconstruction of composite large soft-tissue defects with concomitant bone defects of the lower extremity in a one-stage procedure.

Keywords

latissimus dorsi - vascularized rib - large soft tissue defect - lower extremity

Volltext

Referenzen

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