PMC9553146_01
Patient 1. (A) Upon arrival at the emergency room, the blood circulation in the right foot was poor. (B) Multiple fractures and dislocations were observed after performing radiographic examination. (C) The recipient artery was interposed with T portion and the flow was sutured through anastomosis to the TP artery. (D) On day 9, free LD flap was performed. Abbreviation: (E) After the third tangential excision (4 weeks after LD flap). (F) Appearance at 3.5 months after injury. TP: tibialis posterior artery; SSA: subscapular artery; CSA: circumflex scapular artery; TDA: thoracodorsal artery; LD: latissimus dorsi.
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Upon his arrival at the emergency room, his right foot was ischemic (Figure 1(A,B)). On day 9 after injury, reconstruction was performed using free LD flap (Figure 1(C,D)). In this procedure, the skin was harvested from the ipsilateral thigh 4 weeks after free LD flap (Figure 1(E)). The patient had to wear a non-weight-bearing brace for 3 months owing to concomitant skeletal injury (Figure 1(F)).
PMC9553146_02
(A) Appearance on his arrival. (B) Radiographic findings show ankle dislocation fracture. (C) Free LD flap was performed at 4 weeks after injury. The recipient artery was interposed with T portion and the flow was sutured through anastomosis to the TP artery. (D) The fourth tangential excision was performed at 3.5 weeks after free LD flap. (E) Findings at 3 months after free LD flap. TP: tibialis posterior artery; SSA: subscapular artery; CSA: circumflex scapular artery; TDA: thoracodorsal artery; LD: latissimus dorsi; LD: latissimus dorsi TDA: thoracodorsal artery; UA: ulnar artery.
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He was transferred to our hospital 7 h after his injury (Figure 2(A,B)). After the infection subsided, soft tissue reconstruction was performed using free LD flap at 4 weeks after injury (Figure 2(C)). On day 6 after flap reconstruction, the first tangential excision was performed, and several tangential excisions were repeated using a razor blade, arthroscopic shaver, and hydrosurgery system (Figure 2(D)). The patient could walk with regular shoes without assistance (Figure 2(E)).
PMC9553146_03
(A) Appearance on his arrival. (B) Radiographic examination on his arrival. (C) Free LD flap was performed at 1 week after injury. The recipient artery was sutured end-to-end to the ulnar artery. (D) After the third tangential excision, (E) Findings at 3 months after free LD flap. LD: latissimus dorsi.
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His arm was caught in a conveyor belt (Figure 3(A,B)). A free LD flap was performed to cover the 18 x 15-m soft tissue defect at 1 week after revascularization, waiting until blood circulation stabilized (Figure 3(C)). Three tangential excision procedures were performed in total followed by FTSG 4 weeks after flap reconstruction (Figure 3(D)). Then, the patient could wear regular clothes and use his hand (Figure 3(E)).