title: Intraoperative flap design using ICG monitoring of a conjoined fabricated anterolateral thigh/tensor fasciae latae perforator flap in a case of extensive soft tissue reconstruction at the lower extremity.
abstract: In this report, we present a case of the use of a conjoined fabricated free anterolateral thigh (ALT)/tensor fascia latae (TFL) perforator flap for reconstruction of the lower extremity with intraoperative flap design using intraoperative indocyanine green (ICG) monitoring. The flap was used for reconstruction of a 16 cm × 28 cm sized defect of the lower leg in a 24-year-old man. The defect was caused by a third degree open fracture to the tibia. Upon dissection of the ALT perforators, ICG monitoring showed that both dominant ALT perforators did not yield a sufficient perforasome (∼16 cm × 17 cm) for the larger flap needed. An adjacent TFL perforator also supplied a large perforasome (∼15 cm × 11 cm), so a conjoined fabricated flap was harvested and transplanted to cover an extensive lower leg defect. The artery of the TFL perforator pedicle was being in-flap anastomosed to a side branch of the ALT pedicle. Postoperative course was uneventful and there were no complications. Length of follow-up was 6 months, aesthetic and functional outcome was good. The patient was very satisfied with the aesthetic outcome. Both legs were fully mobile after intensive physiotherapy for the reconstructed leg. The leg where the flap had been harvested showed full strength in knee joint flexion. This case could show that identification of the supplying vessels may be possible by ICG monitoring. © 2015 Wiley Periodicals, Inc. Microsurgery 36:684-688, 2016.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Buehrer
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Taeger
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Ludolph
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Justus P
authors.initials: JP
authors.lastname: Beier
mesh_terms: D000328:Adult; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013848:Thigh
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green