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One-stage double free flap arteriovenous loop reconstruction of a massive abdominothoracic defect following necrotizing fasciitis: a case report

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. Reconstruc...

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Main Authors: Falkner, Florian (Author) , Thomas, Benjamin (Author) , Hundeshagen, Gabriel (Author) , Wittenberg-Rump, Gerhard (Author) , Bliesener, Björn (Author) , Bigdeli, Amir Khosrow (Author) , Kneser, Ulrich (Author)
Format: Article (Journal)
Language:English
Published: 21 October 2020
In: Microsurgery
Year: 2020, Volume: 40, Issue: 8, Pages: 911-915
ISSN:1098-2752
DOI:10.1002/micr.30673
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1002/micr.30673
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.30673
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Author Notes:Florian Falkner MD, Benjamin Thomas MD, Gabriel Hundeshagen MD, MMS, Gerhard Wittenberg MD, Björn Bliesener MD, Amir K. Bigdeli MD, Ulrich Kneser MD
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Summary: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.
Item Description:Gesehen am 17.08.2021
Physical Description:Online Resource
ISSN:1098-2752
DOI:10.1002/micr.30673

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