PMC6108076_01
Side view at the time of presentation to the author. Note Defect involving the ankle and dorsum of the foot area.
gr1.jpg
PMC6108076_01_gr1.jpg
fig0005
A healthy 9 year old girl sustained a compound open tibia fibula fracture with amplex skin and soft tissue trauma that caused a sizable defect 10 x 7 cm over the ankle and dorsum of the foot area, after she was involved in motor vehicle crash (Fig. 1).
Front view on table marking for the left ALT flap donor site harvest with the perforator site located.
gr2.jpg
PMC6108076_01_gr2.jpg
fig0010
Dissection started medially after standard ALT flap marking performed (Fig. 2).
Front view Rectus femoris muscle dissected proximally and distally in-situ.
gr3.jpg
PMC6108076_01_gr3.jpg
fig0015
To avoid further compromise and morbidity to the thigh and another incision in the other thigh or other donor site, decision was made to complete the rectus femoris dissection from its origin to its insertion at the quadriceps tendon, and use it as free tissue transfer to cover the ankle and foot defect, preserving the motor branch to the remaining quadriceps tendons and muscle (Fig. 3).
Front view The Vascular pedicle to rectus femoris connecting to the descending branch to the lateral femoral circumflex artery.
gr4.jpg
PMC6108076_01_gr4.jpg
fig0020
Muscle flap was completely dissected, and allowed to perfuse on it's pedicle, then divided (Fig. 4, Fig. 5).
Side view flap after inset over the soft tissue defect with penros drain inserted.
gr6.jpg
PMC6108076_01_gr6.jpg
fig0030
Microvascular anastomosis was done in an end to end fashion between the posterior tibial vessels and the descending branch of the lateral circumflex femoral vessels, using simple interrupted 9/0 nylon suture, flap inset was completed, and then was covered with split thickness skin graft (Fig. 6, Fig. 7).