RESUMEN
BACKGROUND: The free flap transfer of a latissimus dorsi flap (LDF) for the closure of sacral wound defects after pelvic exenteration and radiation therapy offers a successful tool of the plastic surgeon. This case report shows the successful coverage using an upstream arterio-venous (AV) loop in combination with an LDF. CASE PRESENTATION: We describe the case of a patient who underwent a pelvic exenteration and radiation therapy due to a local recurrence of rectal cancer. The initially used VRAM flap could not ensure a satisfactorily wound closure. An interdisciplinary approach first yielded an AV loop using both greater saphenous veins and was connected to the arteria and vena femoris followed by a free LDF transfer, which was performed 11 days later. The result was an excellent reconstructive and plastic coverage of the sacral wound defect with a well-perfused LDF. The long-term result showed a perfectly integrated flap in the sacral region. CONCLUSION: We recommend the free LDF for the coverage of large wound defects in irradiated areas after the failure of VRAM flap. If an AV loop is necessary within the flap transfer, we recommend conducting two procedures to guarantee the perfusion of the AV loop.
Asunto(s)
Neoplasias Colorrectales/cirugía , Colgajos Tisulares Libres/trasplante , Recurrencia Local de Neoplasia/cirugía , Exenteración Pélvica/efectos adversos , Perineo/cirugía , Procedimientos de Cirugía Plástica/métodos , Sacro/cirugía , Anciano , Neoplasias Colorrectales/patología , Humanos , Masculino , Recurrencia Local de Neoplasia/patología , Perineo/lesiones , Perineo/patología , Complicaciones Posoperatorias , Sacro/lesiones , Sacro/patologíaRESUMEN
Recently, we reported defect coverage in the clavicular region with a scar-sparing pectoralis major flap. We successfully combine this flap with a clavicular reconstruction by an iliac bone graft for non-union now. We propose this reconstructive combination for cases of clavicular non-union with lack of soft tissue coverage.