Atmodiwirjo Parintosa, Ramadan Mohamad Rachadian, Lumbuun Ruth, Gunawan Kevin, Saekhu Mohamad, Nugroho Setyo Widi, Ralena Nadhira Anindita
From the Reconstructive Microsurgery Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia.
Neurosurgery Department, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia.
Plast Reconstr Surg Glob Open. 2024 Sep 16;12(9):e6169. doi: 10.1097/GOX.0000000000006169. eCollection 2024 Sep.
In the context of tuberculous spondylitis, a rare form of extrapulmonary tuberculosis causing significant discomfort and neurological deficits, surgery becomes imperative to alleviate symptoms alongside antituberculosis treatment. However, the utilization of free vascularized fibula flaps for repairing vertebral deformities remains uncommon. This report presents the case of a 21-year-old man with limb weakness and sensory disturbances who was referred to our hospital, where contrast magnetic resonance imaging revealed a paravertebral abscess spanning several thoracic vertebrae. Collaborating with neurosurgeons, we performed decompression laminectomy, pedicle screw fixation, thoracic vertebrectomy, and restoration of the corporal defect using a free fibula flap. Utilizing a 2.5-cm fibula segment from the patient's left leg without a skin paddle, the surgery demonstrated a pedicle length of 12 cm and a total ischemic time of 183 minutes. The fibula was press-fitted, with recipient vessels identified as 1-mm artery and vein from the intercostal artery perforator. Postsurgery, flap vitality was assessed using Doppler ultrasound, showing positive signals immediately and at 1-month follow-up, with the patient experiencing reduced pain and improved leg strength. Despite its rarity, free fibula flap reconstruction for spinal defects proves effective, safe, and beneficial, necessitating thorough preoperative planning and interdisciplinary collaboration for successful outcomes, marking this case as the first reported instance in Indonesia.
在结核性脊柱炎（一种导致严重不适和神经功能缺损的罕见肺外结核形式）的背景下，手术对于在抗结核治疗的同时缓解症状变得至关重要。然而，利用游离带血管腓骨瓣修复椎体畸形的情况仍然不常见。本报告介绍了一名21岁男性病例，该患者因肢体无力和感觉障碍转诊至我院，对比磁共振成像显示有一个跨越多个胸椎的椎旁脓肿。我们与神经外科医生合作，进行了减压椎板切除术、椎弓根螺钉固定、胸椎椎体切除术，并使用游离腓骨瓣修复椎体缺损。利用患者左腿一段2.5厘米长的腓骨（不带皮瓣），手术显示椎弓根长度为12厘米，总缺血时间为183分钟。腓骨采用压配法固定，确定受区血管为肋间动脉穿支的1毫米动脉和静脉。术后，使用多普勒超声评估皮瓣活力，术后即刻及1个月随访均显示阳性信号，患者疼痛减轻，腿部力量增强。尽管罕见，但游离腓骨瓣重建脊柱缺损被证明是有效、安全且有益的，需要进行全面的术前规划和多学科协作以取得成功结果，此病例为印度尼西亚首例报告病例。
