Department of Plastic and Hand Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
World J Surg Oncol. 2019 Sep 2;17(1):154. doi: 10.1186/s12957-019-1698-1.
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.
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.
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.
游离背阔肌皮瓣（LDF）移植用于骨盆切除术和放射治疗后骶部伤口缺损的闭合，为整形外科医生提供了一种成功的工具。本病例报告显示了使用上游动静脉（AV）环结合 LDF 成功覆盖的情况。
我们描述了一位患者的病例，该患者因直肠局部复发而接受了骨盆切除术和放射治疗。最初使用的 VRAM 皮瓣不能确保令人满意的伤口闭合。首先通过联合大隐静脉进行了动静脉环的建立，然后将其连接到股动静脉，随后进行了游离 LDF 转移，11 天后进行了转移。结果是骶部伤口缺损得到了极好的重建和整形覆盖，LDF 灌注良好。长期结果显示，骶部区域的皮瓣完全融合。
我们建议在 VRAM 皮瓣失败后，对于照射区域的大伤口缺损，使用游离 LDF 进行覆盖。如果在皮瓣转移过程中需要 AV 环，则建议进行两次手术以保证 AV 环的灌注。
