Archives of Plastic Surgery

  • 제50권2호
  • /
  • Pages.188-193
  • /
  • 2023
  • /
  • 2234-6163(pISSN)
  • /
  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Cross-Leg Free Flap: Crossing the Border Zone of Ischemic Limb-A Case Report of Limb Salvage Procedure following a Delayed Diagnosis of Popliteal Artery Injury

  • Hui Yuan Lam (Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia) ;
  • Wan Azman Wan Sulaiman (Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia) ;
  • Wan Faisham Wan Ismail (Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia) ;
  • Ahmad Sukari Halim (Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia)
  • 투고 : 2022.07.04
  • 심사 : 2022.10.13
  • 발행 : 2023.03.15
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초록

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

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참고문헌

  1. Chapman JA. Popliteal artery damage in closed injuries of the knee. J Bone Joint Surg Br 1985;67(03):420-423 https://doi.org/10.1302/0301-620X.67B3.3997952
  2. Drapanas T, Hewitt RL, Weichert RF III, Smith AD. Civilian vascular injuries: a critical appraisal of three decades of management. Ann Surg 1970;172(03):351-360
  3. Steele HL, Singh A. Vascular injury after occult knee dislocation presenting as compartment syndrome. J Emerg Med 2012;42(03):271-274 https://doi.org/10.1016/j.jemermed.2008.08.029
  4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977;59(02):236-239 https://doi.org/10.2106/00004623-197759020-00017
  5. Azouz SM, Castel NA, Vijayasekaran A, Rebecca AM, Lettieri SC. Lower-limb reconstruction with chimeric flaps: the quad flap. Microsurgery 2019;39(02):182-187 https://doi.org/10.1002/micr.30335
  6. Yan H, Zhao B, Kolkin J, et al. The management of lower extremity multilevel arterial injuries: a 10-year experience. PLoS One 2015;10(03):e0121769
  7. Perkins ZB, Yet B, Glasgow S, et al. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg 2015;102(05):436-450 https://doi.org/10.1002/bjs.9689
  8. Baghi I, Herfatkar MR, Shokrgozar L, Poor-Rasuli Z, Aghajani F. Assessment of vascular injuries and reconstruction. Trauma Mon 2015;20(04):e30469
  9. Kohli A, Singh G. Management of extremity vascular trauma: Jammu experience. Asian Cardiovasc Thorac Ann 2008;16(03):212-214 https://doi.org/10.1177/021849230801600307
  10. Moini M, Takyar MA, Rasouli MR. Revascularisation later than 24 h after popliteal artery trauma: is it worthwhile? Injury 2007;38(09):1098-1101 https://doi.org/10.1016/j.injury.2007.05.001
  11. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg 1979;64(05):595-604 https://doi.org/10.1097/00006534-197964050-00001
  12. Manrique OJ, Bishop SN, Ciudad P, et al. Lower extremity limb salvage with cross leg pedicle flap, cross leg free flap, and cross leg vascular cable bridge flap. J Reconstr Microsurg 2018;34(07):522-529 https://doi.org/10.1055/s-0038-1641712