Lu Jocelyn, Chavanon Vincent, Margulies Ilana, Yao Alice S
Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, 1 Gustave E. Levy Pl, New York, NY, 10029, USA.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):867-872. doi: 10.1016/j.jcot.2019.08.012. Epub 2019 Aug 14.
Gustilo Grade IIIB and IIIC open fractures of the lower extremity often involve complex wounds requiring bony fixation and soft tissue reconstruction. We present a case of a 32 year-old male who suffered a traumatic Gustilo Grade IIIB open fracture of the tibia and fibula with an extensive soft tissue defect. Reconstruction was first attempted with a turbocharged anterolateral thigh flap that failed due to venous thrombosis. Due to vascular injury, limited reconstructive options were available from the ipsilateral leg. Limb salvage was subsequently achieved with a chimeric cross-leg latissimus dorsi-serratus anterior (LD-SA) free flap based off the contralateral healthy leg, using the serratus for pedicle bridge coverage so that the latissimus could be fully used for defect coverage. Though not extensively described in the literature, this flap is a versatile reconstructive option for limb salvage in patients with Gustilo IIIB or IIIC injuries to the lower extremity.
下肢 Gustilo IIIB 型和 IIIC 型开放性骨折常伴有复杂创面，需要进行骨固定和软组织重建。我们报告一例 32 岁男性患者，其遭受了胫骨和腓骨的创伤性 Gustilo IIIB 型开放性骨折，并伴有广泛的软组织缺损。首次尝试采用股前外侧带蒂皮瓣进行重建，但因静脉血栓形成而失败。由于血管损伤，同侧下肢可供选择的重建方式有限。随后，采用基于对侧健康下肢的嵌合式交腿背阔肌 - 前锯肌（LD - SA）游离皮瓣成功保肢，利用前锯肌作为蒂桥覆盖，使背阔肌能够充分用于覆盖缺损。尽管该皮瓣在文献中未被广泛描述，但它是下肢 Gustilo IIIB 型或 IIIC 型损伤患者保肢的一种多功能重建选择。
