PMC4996068_01
T1 (A) and T2 (B) MRI axial sections showing sacral fracture. (C) Radiography showing external fixation for bilateral ilio-ischio-pubic fractures and coiling of both internal iliac arteries.
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A 52-year-old man known for schizophrenia attempted suicide with a 12 m fall, leading to open book pelvic fracture resulting in hemorrhagic shock (Figure 1).
Pre operative angio-CT locating L4 lumbar perforators (red arrows).
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Planification included angio-CT (Figure 2) with 3D reconstruction to exactly localize lumbar perforators.
(A) Lumbo-sacral defect extending from L4 to S4 (B) Preoperative skin markings with perforators. (C) Intraoperative flap raising after extensive bone debridement (head of patient on the left, feet on the right). (D) Venous congestion on the left LAP flap right requiring stich removal and partial secondary closure. (E) Uneventful healing after secondary closure. (F) Postoperative follow-up (three months).
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The horizontal distance from the posterior midline to the perforators was 9 cm on both sides and the distance from the posterior midline to the medial edge of the flap was 4 cm (Figure 3A and B). After extensive bone debridement with posterior corpectomy and dura mater exposure, flaps were raised on each side (23 x 10 cm and 20 x 10 cm; left and right sides, respectively) (Figure 3C). Aesthesio, DanMic Global, San Jose, California, USA). A peroperative venous congestion required skin secondary closure at 6 d (Figure 3D). Wound healing was uneventful (Figure 3E and F).