Resurfacing of lower extremities: Versatility of thigh flap as pedicle extension graft with consecutive thoracodorsal artery perforator‐based flap

Abstract

Background For successful microsurgical reconstruction using free tissue transfer, healthy recipient vessels must be obtained from outside the zone of injury. Securing an appropriate length pedicle length is also essential, and various techniques for lengthening a vascular pedicle have been developed. Herein, we present our experience using the descending branch (DB) of the lateral circumflex femoral vessels (LCFVs) with a thigh flap as an extender graft for consecutive second flap. Methods We reconstructed the complex and vessel‐depleted defects of nine patients. The mean age was 47.6 years. The defects were located in the lower leg in four patients, in the perineum in two patients and in the forearm in three patients. The two patients who suffered from Fournier's gangrene underwent a pedicled anteromedial thigh (pAMT) flap with the DB of the LCFVs and seven patients, five who suffered high‐energy trauma and two who had scar contracture, underwent a free anterolateral thigh (ALT) flap with the distal run‐off DB of the LCFVs. In all patients, second consecutive free latissimus dorsi or thoracodorsal artery perforator flaps were prepared and the thoracodorsal vessels of the second flap were anastomosed to the distal DB of the LCFVs. Results The total length of the thigh flap pedicles measured from both ends of the DB of the LCFVs varied from 15 to 20 cm, which was sufficient for use as a vascular conduit. Of the 18 flaps, 17 survived completely without any complications and 1 pAMT flap showed partial necrosis, which was covered with a perineal perforator‐based island flap. The mean follow‐up period was 16.7 months. Unfortunately, one patient, who suffered a total amputation below the knee and had replantation surgery, underwent amputation due to venous congestion in the distal leg. However, the previous two flaps survived and were used for coverage of the stump. Conclusions Using a thigh flap as a vascular extender graft for second flap may be an alternative option in vessel‐depleted reconstructions.

Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one‐stage lower extremity reconstruction: A case report

“…It was described in the literature that providing large soft tissue volume up to 630 cm 2 was possible (Saint‐Cyr et al, 2009). However, localizations of the defects, distance to recipient vessels and design of the flap inset have also a decisive role on flap choose so double fasciocutaneous flaps were performed even for smaller defects (Choi et al, 2022; Qing et al, 2015) previously. After debridement of poor conditioned skin, both flaps (314 cm 2 ) were able to cover all defects of our patient.…”

“…They used the muscle component of the chimeric flaps for dead space and skin islands of double‐free flaps for the reconstruction of large defects. Choi et al (2022) performed sequential free flaps for lower extremity reconstructions. For one of their cases, they used saphenous veins as grafts to lengthen the pedicle of sequential double flaps to reach recipient vessels in reconstruction of depleted lower extremity.…”