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One‐stage double free flap arteriovenous loop reconstruction of a massive abdominothoracic defect following necrotizing fasciitis: A case report
Author(s) -
Falkner Florian,
Thomas Benjamin,
Hundeshagen Gabriel,
Wittenberg Gerhard,
Bliesener Björn,
Bigdeli Amir K.,
Kneser Ulrich
Publication year - 2020
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30673
Subject(s) - medicine , surgery , rib cage , scapula , free flap , fasciitis , axillary vein , brachial plexus , sternoclavicular joint , debridement (dental) , stage (stratigraphy) , thrombosis , anatomy , clavicle , paleontology , biology
Abstract We report the case of a 67‐year old male with necrotizing fasciitis after injection of the glenohumeral joint. After extensive debridement a massive defect from the left hip joint to the left upper arm, exposing ribs, scapula, axillary vessels and brachial plexus (45 × 40 cm) was present. Reconstruction was performed with a conjoined right myocutaneous tensor fasciae lata/vastus lateralis flap and a left myocutaneous vastus lateralis flap in combination with an arteriovenous loop originating from the axillary vessels using the greater saphenous vein. Revisional surgeries were necessary including ribs resection and flap re‐advancements. Due to multiorganic failure invasive ventilation, renal replacement‐ and extensive transfusion therapy was required. After 241 days the patient was discharged for rehabilitation. At the 12 months follow‐up wounds were sufficiently closed without the need for further intervention. This case illustrates that immediate diagnosis followed by an aggressive multidisciplinary treatment approach is crucial for the patient survival.