Challenges in Microsurgical Free Tissue Transfer for a 1-Year-Old Child

Challenges faced during complex reconstructions in the pediatric age group are rarely discussed in literature. This study is to share our experience in a 1-year-old patient. The patient had an exposed knee joint following trivial trauma, which was resurfaced with a free latissimus dorsi flap. On the patient’s 5th day in the ward, the flap was discolored and inadequate perfusion was noted. The patient also had loose stools overnight. Before she was re-examined, the dressings were loosened and the patient was kept warm and was started on intravenous fluids. When examined in the operating room, the vascularity of the flap had improved without any intervention. The monitoring skin paddle necrosed while the muscle survived. The patient then underwent skin grafting and had uneventful recovery. The postoperative monitoring in children is critical as they have poor reserves and are prone to complications. We believe pediatric microsurgery should be done in specialized microsurgical centers that also have good intensive care units.

Avoiding Above-the-Knee Amputation with a Free Tibiofibular–Talocalcaneal Fillet Flap and Free Latissimus Dorsi Flap

Despite the advances achieved in reconstructive surgery, amputation is still the only option after some severe traumas. Preservation of the knee joint is considered a significant functional advantage. We present the case of a 39-year-old man with a comminuted Gustilo type IIIC open tibia fracture with massive bone loss. To achieve a well-fashioned amputation stump and preserve the knee joint, a free osteocutaneous fillet flap was performed, including the distal tibia and fibula, talus, and calcaneus bones. As a result, a sensate and long amputation stump covered with thick skin from the sole of the foot provided a stable coverage with an excellent functional result and adjustment to prosthesis.

Free Latissimus Dorsi Flap With Femoral Artery End-to-Side Anastomosis for Perineal Reconstruction Following Fournier’s Gangrene

Fournier’s gangrene is a necrotizing infection of the soft tissue structures of the perineum that can extend quickly, requiring aggressive and repeated surgical debridement. This can result in extensive tissue loss and functional impairment, creating reconstructive challenges for plastic surgeons. We present a case of Fournier’s gangrene which resulted in complete loss of the pelvic floor musculature and functional loss of the urinary and fecal outlets. Given the extent of the defect and involvement of areas that would traditionally be used as donor site for local and regional flaps, reconstruction was sought with a free latissimus dorsi flap in combination with split-thickness skin grafting following serial debridement and negative pressure wound therapy. The patient survived and made a satisfactory recovery.

Case Report: Free Latissimus Dorsi Flap in Combination With Subdural Space Reduction for the Prevention of Recurrent Hemorrhage Following Hemispherectomy

BACKGROUND AND IMPORTANCE Extensive cerebral resections for the treatment of epilepsy may result in a large intracranial dead space that is prone to recurrent hemorrhage, either due to mechanical dislodgement or the development of extensive subdural membranes. Several techniques have been proposed to decrease the risk of hemorrhage by either reducing or filling the remaining intracranial dead space. CLINICAL PRESENTATION We present a case of persistent hemorrhage following functional hemispherectomy in a patient with a large porencephalic cyst. A treatment strategy involving both subdural space reduction and cranial vault filling with a vascularized free latissimus dorsi flap is discussed. CONCLUSION Subdural space reduction and cranial vault filling with a vascularized free latissimus dorsi flap is a viable treatment alternative in patients with large areas of intracranial dead space.