Subtotal extended thigh flap

Article information

Arch Plast Surg. 2020;47(1):106-107

Publication date (electronic) : 2019 August 30

doi : https://doi.org/10.5999/aps.2018.01088

Paolo Persichetti, Daniele Tosi, Pietro Francesco Delle Femmine, Giovanni Francesco Marangi

Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Roma University, Rome, Italy

Correspondence: Daniele Tosi Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Roma University, Via A. del Portillo 200, Rome 00128, Italy Tel: +39-6-225411224, Fax: +39-6-225411220, E-mail: tosi.da@gmail.com

Received 2018 August 28; Revised 2019 June 29; Accepted 2019 July 9.

In 2010, Chang et al. [1] reported closing a wound after hemicorporectomy using a bilateral subtotal thigh flap. We describe a subtotal extended thigh flap for a 42-year-old male quadriplegic patient who presented with a nonmetastatic Marjolin ulcer (Fig. 1). Magnetic resonance imaging revealed that soft tissues, the coccyx, and the sacrum bone up to the S2 vertebra were involved.

Fig. 1.

Marjolin’s ulcer on the sacral region involving the posterior surface of the sacral bone.

The only option for radical excision of the tumor was subtotal sacrectomy. Total sacral bone disarticulation between S1 and S2, ligation of the thecal sac, and removal of soft tissue and the residual gluteus muscles were performed. A posterolateral femur incision was made (Fig. 2). The popliteal vessels were ligated. Dissection was carried out through the posterolateral intermuscular thigh septum. The flap was harvested distally to proximally. The hamstring muscles were removed to avoid a bulk effect. We obtained a dually-structured flap, with a myo-fasciocutaneous portion (anterolateral side) and a fasciocutaneous portion (medial side) (Fig. 3). The anterolateral portion of the flap was vascularized by perforators from the superficial and deep femoral arteries, while the fasciocutaneous portion of the flap was supplied by perforators from the profunda femoris artery. The flap surface measured 50×38 cm (Fig. 4). The posteromedial component of the flap represented an extension of the flap that allowed the total flap surface to be increased; moreover, the fasciocutaneous component was vascularized by a well-known and secure pattern of perforators.

Fig. 2.

Posterolateral femur cutaneous incision planned for harvesting the subtotal extended thigh flap.

Fig. 3.

Subtotal extended thigh flap (A), containing a myo-fasciocutaneous anterolateral portion (solid line) and a fasciocutaneous medial portion (dashed line) (B).

Fig. 4.

(A, B) Patient in the prone and supine positions during his 5th day in the intensive care unit.

This modification of the original flap enabled the flap surface to be enlarged, which could be useful in extreme cases of total or subtotal sacral resection.