PMC2772273_01
Giant right trochanteric pressure sore with exposed trochanters and gangrenous tensor fascia lata. Doppler identified perforators are marked
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F0001
An examination revealed a giant right trochanteric sore measuring 24 x 14 cms [Figure 1]. Preoperative portable Doppler marking of the anterolateral thigh perforator was done and was suggestive of two terminal prominent branches [Figure 1].
Lateral circumflex femoral artery with branches to skin and vastus lateralis dissected and taped
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This revealed an intact branch to the middle third of the vastus lateralis apart from the skin supply [Figure 2].
Paddles of vastus (proximal) and skin (distal) raised on perforator branches
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F0003
A chimeric flap was pedicled on the lateral circumflex femoral artery using the anterolateral thigh fasciocutaneous and vastus lateralis muscle component on separate perforator branches [Figure 3].
Muscle component placed proximally over the debrided trochanteric area and fasciocutaneous component placed distally over femur shaft
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F0004
The donor site could be primarily closed except a 6 x 2 cms strip over the distal extent, which was also covered by skin graft [Figure 4].
Well consolidated flaps 2 months after the surgery
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F0005
At a 2-month follow-up visit, the flaps were stable with no recurrence of ulceration [Figure 5].