Abstract
Background A 61-year-old patient presented with a right Girdlestone hip and wound dehiscence
due to extensive dead space after radical debridement and septic arthroplasty removal.
A two-stage reconstruction with the application of a subcutaneous autologous arterio-venous
(AV) loop using an autologous vena saphena magna (VSM) interposition graft followed
by a free latissimus dorsi flap was performed.
Method We decided to perform a two-stage procedure with AV loop creation in the first step
and free flap transplantation seven days after it. In the first step, an AV vascular
loop was prepared by transplanting the contralateral VSM interposition graft to the
inguinal femoral vessels with subcutaneous passage of the venous loop. In the second
step after 7 days, the wound was closed by a two-team approach. One surgical team
completed the wound debridement, while the other team harvested the flap by microsurgical
preparation of the thoracodorsal pedicle in the right axilla. Upon completed harvest,
the flap was placed into the wound to fill the periosseous dead space, and the anastomosis
was performed in an end-to-end fashion.
Result The patient remained free of infection with a well-healed flap. He was mobilized
on crutches with partial weight bearing on the operated leg. A lower extremity prosthesis
with pelvic support was customized.
Key words Girdlestone - hip resection arthroplasty - latissimus dorsi - dead space management
- AV loop
