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• W3148959105 abstract "A 49-year-old man was involved in an accident while felling trees. A large tree trunk slipped onto his left leg, degloving the anterior surface and also crushing his leg above the ankle. The pretibial area from the tibia1 tuberosity to the ankle had been stripped of skin and, in some areas, the periosteum. The injury continued posteriorly and laterally around a fracture of the distal fibula exposing the tendo Achilles (Fig. 1). The anterior tibia1 artery was divided. The fracture of the fibula was a compound, complex fracture with one intermediate segment in the distal third (Fig. 2). The inferior tibio-fibular diastasis was intact. The patient was taken to theatre the same day and the wound debrided. This revealed areas of bone along the subcutaneous border of the tibia denuded of periosteum and also the extent of the exposed tendons from the extensor and peroneal compartments in addition to the exposed tendo Achilles. These structures were covered with a single radial forearm-lateral arm mega free flap measuring 44 x 10 cm (Fig. 3). The remaining areas were covered with split skin grafts. The flap was raised, beginning on the radial forearm and continuing to the lateral arm including the cephalic vein. Care was taken to keep the flap fasciocutaneous over the lateral epicondyle. Both vascular pedicles were dissected and harvested. The radial artery was anastomosed first to the proximal end of the divided anterior tibia1 artery (end to end), just above the ankle joint. The proximal end of the cephalic vein was then anastomosed to the saphenous vein at the level of the knee and the posterior radial collateral vein to a branch of the saphenous vein. The flap did not require additional arterial input from the posterior radial collateral artery, which had ample back flow and was ligated. The flap survived in its entirety (Fig. 4), although the proximal part of the lateral arm portion was mildly congested for 2 days. The donor site required skin grafting (Fig. 5). There was some delayed healing on the leg of the area covered by split skin graft, which required some local debridement before totally healing. The patient was reviewed at 2 months after surgery when all wounds were well healed but he continued to have a persistent deficiency of toe and ankle extension." @default.
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• W3148959105 date "2004-01-01" @default.
• W3148959105 modified "2023-09-23" @default.
• W3148959105 title "The radial forearm-lateral arm mega free flap" @default.
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