Geierlehner Alexander, Ludolph Ingo, Arkudas Andreas, Horch Raymund E
Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Germany.
Plast Reconstr Surg Glob Open. 2021 Nov 22;9(11):e3881. doi: 10.1097/GOX.0000000000003881. eCollection 2021 Nov.
This study presents a novel surgical technique for the reconstruction of highly challenging large lower back defects. In this case, a 72-year-old man initially diagnosed with renal cell carcinoma received nephrectomy followed by the dissection of an iliac crest metastasis and repeated high-dose irradiation therapy. Several years later, an osteocutaneous fistula at the right caudal posterior trunk made the reconstruction of the lower back defect necessary. High-dose irradiation of the lower back and poor vascular conditions at the pelvic region disqualified the patient for previously published local or free flap options. The initial strategy of an arteriovenous loop anastomosed to the femoral vessels and a free latissimus dorsi flap transfer had to be withdrawn due to repeated intraoperative loop thrombosis. For that reason, the entire latissimus dorsi muscle was used as a myocutaneous propeller flap receiving its blood supply solely through a single dorsal intercostal artery perforator. The flap survived completely and no fistulous formation occurred postoperatively. The time to complete wound healing was 4 months. This new technique is considered a valuable addition for the reconstruction of challenging posterior caudal trunk defects.
本研究提出了一种用于重建极具挑战性的下背部大缺损的新型手术技术。在该病例中，一名72岁男性最初被诊断为肾细胞癌，接受了肾切除手术，随后进行了髂嵴转移灶切除术及反复高剂量放射治疗。数年后，右尾侧后躯干出现骨皮瘘，使得下背部缺损的重建成为必要。下背部的高剂量放疗以及盆腔区域较差的血管条件使患者无法采用先前发表的局部或游离皮瓣方案。由于术中反复出现动静脉袢血栓形成，最初将动静脉袢与股血管吻合并游离背阔肌皮瓣转移的策略不得不放弃。因此，整个背阔肌被用作肌皮推进皮瓣，仅通过单一的肋间后动脉穿支获得血供。皮瓣完全存活，术后未发生瘘管形成。伤口完全愈合的时间为4个月。这项新技术被认为是重建具有挑战性的尾侧后躯干缺损的一项有价值的补充技术。
