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Simple to Extreme: Following the Reconstructive Ladder for Complex Posterior Trunk Reconstruction
Samer Jabbour1, Edward I Chang2, Sahil K Kapur2
1Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, D.C.
Plastic and Reconstructive Surgery. Global Open
|October 14, 2021
Summary
Reconstructing complex torso defects after cancer surgery can be challenging. A free TRAM flap with an arteriovenous loop provided successful coverage for a radiated back wound with exposed hardware.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oncology
Background:
- Posterior trunk and torso defects pose significant reconstructive challenges, especially after oncologic resection and adjuvant therapies.
- Hardware exposure complicates reconstruction, often limiting local flap viability.
Observation:
- A unique case involving a complex, radiated back wound with exposed hardware is presented.
- Previous reconstructive attempts using local flaps (bilateral paraspinous, latissimus dorsi, trapezius) had failed.
Findings:
- A unilateral free TRAM (transverse rectus abdominis myocutaneous) flap was successfully employed for reconstruction.
- The flap was revascularized using an arteriovenous loop to ensure stable coverage of a large (15 × 25 cm) defect.
- Preexisting upper extremity ischemia influenced flap perfusion and positioning options.
Implications:
- Microvascular free tissue transfer, specifically free TRAM flaps with arteriovenous loops, offers a viable solution for complex defects when local options are exhausted.
- This technique provides a crucial reconstructive option for patients with challenging wounds, including those with exposed hardware and prior radiation.
- Arteriovenous loops can enhance flap viability in compromised vascular states, expanding reconstructive possibilities.
