One‐stage double free flap arteriovenous loop reconstruction of a massive abdominothoracic defect following necrotizing fasciitis: A case report

Abstract

We report the case of a 67‐year old male with necrotizing fasciitis after injection of the glenohumeral joint. After extensive debridement a massive defect from the left hip joint to the left upper arm, exposing ribs, scapula, axillary vessels and brachial plexus (45 × 40 cm) was present. Reconstruction was performed with a conjoined right myocutaneous tensor fasciae lata/vastus lateralis flap and a left myocutaneous vastus lateralis flap in combination with an arteriovenous loop originating from the axillary vessels using the greater saphenous vein. Revisional surgeries were necessary including ribs resection and flap re‐advancements. Due to multiorganic failure invasive ventilation, renal replacement‐ and extensive transfusion therapy was required. After 241 days the patient was discharged for rehabilitation. At the 12 months follow‐up wounds were sufficiently closed without the need for further intervention. This case illustrates that immediate diagnosis followed by an aggressive multidisciplinary treatment approach is crucial for the patient survival.

Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes

“…Vastus lateralis flaps have been employed as free flaps for craniofacial as well as head and neck reconstruction 47–50 . Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds 13,14,16,17,51–54 …”

“…[47][48][49][50] Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds. 13,14,16,17,[51][52][53][54] To our knowledge, a pedicled vastus lateralis myocutaneous flap has not been described for coverage of defects after resection of sacropelvic tumors. Observing that the use of gastrocnemius flaps for coverage of proximal tibia and distal femur defects after sarcoma resection about the knee has led to decreased wound complications, we hypothesized that a pedicled vastus lateralis flap can serve as an analog for sacropelvic and proximal femur tumors.…”

“…Multiple flaps have been described for soft tissue reconstruction of large defects after sacropelvic tumor resection such as the pedicled vertical rectus abdominis musculocutaneous (VRAM), gluteal myocutaneous, latissimus dorsi, and anterolateral thigh (ALT) flaps 2,7,11 . Due to its bulk and low donor site morbidity, the vastus lateralis flap has been described for coverage in the setting of trauma, chronic wounds, and necrotizing fasciitis 12–17 . This flap has not been described for coverage of defects from sacropelvic tumor resection.…”

“…2,7,11 Due to its bulk and low donor site morbidity, the vastus lateralis flap has been described for coverage in the setting of trauma, chronic wounds, and necrotizing fasciitis. [12][13][14][15][16][17] This flap has not been described for coverage of defects from sacropelvic tumor resection.…”