Agarwal Rishi Raj, Broder Kevin, Kulidjian Anna, Bodor Richard
From the *Department of Surgery, †Department of Surgery, Division of Plastic and Reconstructive Surgery, and ‡Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA.
Ann Plast Surg. 2014 May;72 Suppl 1:S2-5. doi: 10.1097/01.sap.0000435799.96674.9f.
We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.
我们报告了成功使用延长的腓肠肌外侧肌皮瓣，通过连续延迟提升来覆盖股骨中外侧。一名62岁男性10年前接受了右大腿前部脂肪肉瘤的广泛切除，采用游离皮瓣重建并随后进行了放射治疗。四年后，患者的放疗后股骨发生骨折，接受了逆行髓内钉治疗，随后感染，导致股骨远端骨髓炎、膝关节化脓性关节炎以及病理性骨折不愈合。尽管众多外科医生建议进行膝上截肢，但我们为这位积极的患者提供了多学科方法来清除感染和病变；植入新的骨科硬件；进行延迟皮瓣重建；并使他恢复到无痛、无需辅助的行走状态。所使用的延长腓肠肌外侧肌皮瓣为患者膝关节线以上14厘米处股骨中外侧暴露的骨科硬件提供了有血运的软组织和持久的覆盖。通过使用该皮瓣覆盖远高于已发表高度的股骨缺损，我们的患者在多年功能恶化后避免了截肢。
