Radwan Mohammad S, Mashal Ashraf A
Division of Plastic and Reconstructive Surgery, Bethlehem Arab Society for Rehabilitation and Specialized Surgery Hospital, Bethlehem, State of Palestine.
Plast Reconstr Surg Glob Open. 2020 Mar 11;8(3):e2707. doi: 10.1097/GOX.0000000000002707. eCollection 2020 Mar.
Reconstruction of posttraumatic soft tissue defects has been revolutionized after the application of microvascular free flaps. However, standard flaps are limited in size and may not completely cover the defect. Flap expansion which is indicated in large defects with extensive soft tissue loss or shortage of donor tissue enables tension-free closure of large defects, minimal donor site morbidity, and better aesthetic outcomes. The literature review revealed a higher complication rate in the expansion of free flaps implanted in the extremities. A 7-year-old Palestinian girl presented with right foot crush injury and open multiple metatarsal and tarsal bone fractures with significant soft tissue loss. She underwent free latissimus dorsi flap transfer and overlying skin graft island application followed months later by expander implantation within the flap. This flap was serially expanded once a week for 4 months, until its dimension was declared to be large enough to cover the foot defect. We successfully transferred a free flap to a foot with extensive tissue loss. The overlying skin island contracted and minimized the defect size. The flap was serially expanded until completely covered the defect. No features of vascular compromise or other complications occurred; the flap remained viable with good aesthetic outcome. Posttransfer free flap expansion in lower limb defects can be utilized with meticulous care and follow-up for reconstruction of large defects.
微血管游离皮瓣的应用彻底改变了创伤后软组织缺损的修复方式。然而，标准皮瓣尺寸有限，可能无法完全覆盖缺损。对于存在广泛软组织缺失或供区组织不足的大缺损，皮瓣扩张术可实现大缺损的无张力闭合、供区并发症最少以及更好的美学效果。文献综述显示，植入四肢的游离皮瓣扩张并发症发生率较高。一名7岁的巴勒斯坦女孩因右脚挤压伤就诊，伴有多处开放性跖骨和跗骨骨折及严重软组织缺失。她接受了背阔肌游离皮瓣转移及皮瓣上覆盖的岛状皮片移植，数月后在皮瓣内植入扩张器。该皮瓣每周连续扩张一次，共4个月，直至其尺寸被认为足够大以覆盖足部缺损。我们成功地将游离皮瓣转移至组织广泛缺失的足部。覆盖的皮岛收缩，使缺损尺寸最小化。皮瓣连续扩张直至完全覆盖缺损。未出现血管受压或其他并发症迹象；皮瓣存活良好，美学效果佳。下肢缺损的游离皮瓣转移后扩张术在精心护理和随访下可用于大缺损的重建。
