Volume 42, Issue 3 pp. 277-281
CASE REPORT

The triple conjoined scapular–latissimus dorsi–groin flap for reconstruction of long lower extremity degloving injury: A case report

Francesco Amendola MD

Francesco Amendola MD

Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy

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Davide Spadoni MD

Davide Spadoni MD

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

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Jonathan Velazquez-Mujica MD

Jonathan Velazquez-Mujica MD

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

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Loukas Platsas MD

Loukas Platsas MD

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

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Hung-Chi Chen MD, PhD, FACS

Corresponding Author

Hung-Chi Chen MD, PhD, FACS

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

Correspondence

Hung-Chi Chen MD, PhD, FACS, Department of Plastic and Reconstructive Surgery, China Medical University Hospital, No. 91, Xueshi Road, North District, Taichung 404, Taiwan.

Email: [email protected]

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First published: 20 October 2021
Citations: 1

Abstract

Since the introduction of the angiosome concept, many attempts have been made to push the dimensional limits of free tissue transfers. While initially limited by the boundaries of random vascularization of adjacent angiosomes, wider flaps were transferred by combining contiguous source vessels. Combined flaps, either chimeric or conjoined, represent nowadays the largest reconstructive options in the human body. This is the first report of a triple conjoined free flap with two vascular anastomoses, able to cover the anterior surface of the entire lower limb, representing the longest flap ever reported in history. A 43-year-old woman sustained a car accident as a pedestrian and presented with a massive circumferential degloving injury of the right lower limb. Femoral displaced shaft fracture and Gustilo type IIIb tibial fracture were diagnosed with emergent CT scan. A myocutaneous latissimus dorsi flap was planned, conjoined with the scapular flap to obtain a thick and large cover for the knee, and with a groin flap, to cover for the foot. Descending branch of lateral circumflex femoral artery and anterior tibial artery at the dorsum of the foot were selected as recipient vessels. Donor site was closed primarily. All flaps survived and no immediate nor late complications were reported. Follow up was 3 months. The triple conjoined flap can be considered a safe and useful reconstructive tool in severe degloving injuries of the lower limb, allowing the coverage of a large surface of the lesion with a single operation and without increasing the donor site morbidity.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author, HCC. The data are not publicly available, as containing information that could compromise the privacy of research participants.

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