Related Experiment Videos
Mycotic aneurysm in a free flap
D M Kalainov1, M Gerwin, L B Gayle
1Hospital For Special Surgery, New York, New York, USA.
Summary
A free gracilis muscle flap was used to cover a large wound after leg surgery. The arterial pedicle ruptured, leading to graft failure and debridement due to bacterial infection.
Area of Science:
- Orthopedic surgery
- Vascular surgery
- Microsurgery
Background:
- Corrective osteotomies of the distal tibia and fibula can result in significant soft tissue defects.
- Free muscle flaps are a reconstructive option for large wounds.
- Vascular pedicle complications can compromise flap viability.
Observation:
- A 41-year-old male presented with a 3 x 4 cm wound post-osteotomy.
- A free gracilis muscle flap was utilized for wound coverage.
- The arterial pedicle of the flap ruptured seven days post-transfer.
Findings:
- The arterial pedicle rupture led to an aneurysm formation.
- Attempted aneurysm repair was unsuccessful, necessitating flap debridement.
- Wound cultures revealed Pseudomonas and Enterobacter cloacae, implicated in the aneurysm.
Implications:
- Vascular pedicle integrity is crucial for free flap survival in orthopedic reconstruction.
- Bacterial contamination may contribute to vascular complications like aneurysm formation.
- This case highlights the potential risks and management challenges associated with free flap reconstruction in complex lower extremity wounds.