Microvascular reconstruction for complex lower-extremity trauma in pregnancy

Microvascular reconstruction in pregnancy is rare. We report a case of complex distal lower-extremity trauma in early pregnancy reconstructed with a microvascular free muscle flap. A 30-year-old female with 13 weeks gestation had a crush avulsion of the distal left leg with medial malleolar fracture; she had two sessions of debridement, joint stabilising external fixator frame, and a vaccum assisted closure dressing application. Two weeks later, a right latissimus muscle flap was harvested. Flap was transferred to the debrided leg defect. The thoracodorsal vessels were anastomosed end to end to the anterior tibial artery and the concomitant vein. The flap was immediately revascularised. Continuous post-operative heparin infusion was administered. The muscle was covered with split-thickness skin graft 48 hrs later. Healing and post-operative recovery were uneventful. This report suggests that careful surgical and anesthetic techniques, along with a balanced post-operative anticoagulation protocol, can achieve satisfactory microvascular reconstruction in pregnancy.