Free fillet lower leg flap with fenestration of the pelvis as prevention of vascular problem after hemipelvectomy.



Rok publikování 2022
Druh Článek v odborném periodiku
Časopis / Zdroj Journal of plastic, reconstructive & aesthetic surgery
Fakulta / Pracoviště MU

Lékařská fakulta

Klíčová slova Free fillet lower leg flap; pelvis; fenestration; hemipelvectomy; vascular problem
Popis We read with great interest the article by L. Kreutz-Rodrigues et al. from Mayo Clinic: Reconstruction of complex hemipelvectomy defects: a 17-year single-institutional experience with lower extremity free and pedicled flaps1. Congratulations to the authors for the excellent results and for including the largest published group of patients to date. We completely agree with the harvesting technique as described by the authors. We believe that the elevation of the flap with fibula is faster and in addition the fibula can be used to reconstruct the pelvic ring. Certainly, double-team surgery is standard for time-saving and minimising the ischaemia time. However, we consider the use of a pedicled flap with rotation of the pedicle in the pelvis or bending of the vascular pedicle around the edge of iliac crest too risky. It can cause venous thrombosis, as described by Kreutz-Rodrigues et al.1. Previous studies have reported the occurrence of venous thrombosis in three out of seven cases. We propose a technique where the vascular pedicle can be inserted into the pelvis through a bone window, allowing for successful vascular anastomosis without any vascular complications.

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