case_images: PMC8204669_01
case_images: Preoperative defect
case_images: IPRS-10-05-g-001.jpg
case_images: PMC8204669_01_IPRS-10-05-g-001.jpg
case_images: F1
case_images: Negative wound pressure therapy (NPWT) was used for coverage and preconditioning of the 8 x 18 cm soft tissue defect (Figure 1 (Fig. 1)).
case_images: Defect with AV loop in situ
case_images: IPRS-10-05-g-002.jpg
case_images: PMC8204669_01_IPRS-10-05-g-002.jpg
case_images: F2
case_images: Preceding the free LD flap an AV loop system (AV loop marked * in Figure 2 (Fig. 2)) was constructed by the vascular surgery department on the popliteal P3 segment.
case_images: LD flap plus split skin graft and monitor island
case_images: IPRS-10-05-g-003.jpg
case_images: PMC8204669_01_IPRS-10-05-g-003.jpg
case_images: F3
case_images: The patient was thus ready to have the defect covered by means of a free LD flap with microvascular connection to the AV loop and simultaneous split skin coverage plus a monitor island (marked *) for better flap observation (Figure 3 (Fig. 3)) after 7 days of Doppler monitoring the AV loop. The final examination verified excellent blood circulation of the flap and monitor island (Figure 3 (Fig. 3)).
case_images: Postoperative result after 2 weeks
case_images: IPRS-10-05-g-004.jpg
case_images: PMC8204669_01_IPRS-10-05-g-004.jpg
case_images: F4
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)).
case_images: Postoperative result after 2 weeks
case_images: IPRS-10-05-g-005.jpg
case_images: PMC8204669_01_IPRS-10-05-g-005.jpg
case_images: F5
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)). Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7) and Figure 8 (Fig. 8) show the patient standing and able to walk with no crutches.
case_images: Postoperative result after 6 months, frontal view
case_images: IPRS-10-05-g-006.jpg
case_images: PMC8204669_01_IPRS-10-05-g-006.jpg
case_images: F6
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)). Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7) and Figure 8 (Fig. 8) show the patient standing and able to walk with no crutches.
case_images: Postoperative result after 6 months, lateral view
case_images: IPRS-10-05-g-007.jpg
case_images: PMC8204669_01_IPRS-10-05-g-007.jpg
case_images: F7
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)). Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7) and Figure 8 (Fig. 8) show the patient standing and able to walk with no crutches.
case_images: Postoperative result after 1.5 years, frontal view
case_images: IPRS-10-05-g-008.jpg
case_images: PMC8204669_01_IPRS-10-05-g-008.jpg
case_images: F8
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)). Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7) and Figure 8 (Fig. 8) show the patient standing and able to walk with no crutches.
case_images: Postoperative result after 1.5 years, lateral view
case_images: IPRS-10-05-g-009.jpg
case_images: PMC8204669_01_IPRS-10-05-g-009.jpg
case_images: F9
case_images: The initial care was performed by the outpatient unit with weekly follow-up visits and short-term visits after 2 and 8 weeks (Figure 4 (Fig. 4) and Figure 5 (Fig. 5)), 6 months (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)) and 1.5 years post-surgery (Figure 8 (Fig. 8) and Figure 9 (Fig. 9)).
case_images: Posteropative X-rays after 1 year
case_images: IPRS-10-05-g-010.jpg
case_images: PMC8204669_01_IPRS-10-05-g-010.jpg
case_images: F10
case_images: The X-rays (Figure 10 (Fig. 10)) one year after bone fixation showed no sign of bone infection or pseudarthrosis after removal of the external fixator.
case_images: Intraoperative patient positioning
case_images: IPRS-10-05-g-011.jpg
case_images: PMC8204669_01_IPRS-10-05-g-011.jpg
case_images: F11
case_images: The patient was placed in a right lateral position allowing a two-team approach (Figure 11 (Fig. 11)).
case_images: Harvested LD flap
case_images: IPRS-10-05-g-012.jpg
case_images: PMC8204669_01_IPRS-10-05-g-012.jpg
case_images: F12
case_images: Venous anastomosis perfomed with 3.0 mm coupler
case_images: IPRS-10-05-g-013.jpg
case_images: PMC8204669_01_IPRS-10-05-g-013.jpg
case_images: F13
case_images: Under the surgical microscope, the venous anastomosis was performed with a 3.0 mm venous coupler (Figure 13 (Fig. 13)) whereas the arterial anastomosis was carried out using 8/0 Prolene single-button sutures (Figure 14 (Fig. 14)).
case_images: Arterial anastomosis, single button 8.0 Prolene sutures
case_images: IPRS-10-05-g-014.jpg
case_images: PMC8204669_01_IPRS-10-05-g-014.jpg
case_images: F14
case_images: Under the surgical microscope, the venous anastomosis was performed with a 3.0 mm venous coupler (Figure 13 (Fig. 13)) whereas the arterial anastomosis was carried out using 8/0 Prolene single-button sutures (Figure 14 (Fig. 14)).
case_images: LD flap after anastomosis covering the defect
case_images: IPRS-10-05-g-015.jpg
case_images: PMC8204669_01_IPRS-10-05-g-015.jpg
case_images: F15
case_images: After an ischemic time of 56 min the anastomoses were released and an excellent blood flow through the entire latissimus dorsi flap with instant capillarization of the monitor island could be seen (Figure 15 (Fig. 15)).