Page 81 - Read Online

Arkudas et al. Plast Aesthet Res 2018;5:38 Plastic and
DOI: 10.20517/2347-9264.2018.44 Aesthetic Research

Case Report Open Access

Defect reconstruction of the trochanter major after
necrotizing fasciitis and multiple operations using

an arteriovenous loop and latissimus dorsi free flap

Andreas Arkudas¹, Susanne Regus², Alexander Meyer², Werner Lang², Marweh Schmitz¹, Raymund E.
Horch¹

1 Department of Plastic and Hand Surgery, University Hospital of Erlangen , Friedrich-Alexander-University of Erlangen-Nürnberg (FAU),
Erlangen 91054, Germany.
2 Department of Vascular Surgery, University Hospital of Erlangen , Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen
91054, Germany.
Correspondence to: Dr. Andreas Arkudas, Department of Plastic and Hand Surgery, University Hospital of Erlangen , Friedrich-
Alexander-University of Erlangen-Nürnberg (FAU), Erlangen 91054, Germany. E-mail: andreas.arkudas@uk-erlangen.de

How to cite this article: Arkudas A, Regus S, Meyer A, Lang W, Schmitz M, Horch RE. Defect reconstruction of the trochanter major
after necrotizing fasciitis and multiple operations using an arteriovenous loop and latissimus dorsi free flap. Plast Aesthet Res 2018;5:38.
http://dx.doi.org/10.20517/2347-9264.2018.44
Received: 10 Jun 2018 First Decision: 15 Aug 2018 Revised: 22 Aug 2018 Accepted: 22 Aug 2018 Published: 28 Sep 2018

Science Editor: Raymund Engelbert Horch Copy Editor: Yuan-Li Wang Production Editor: Zhong-Yu Guo

Abstract

Necrotizing fasciitis (NF) is a severe soft tissue infection which has to be treated with a radical debridement as the key
element. In the further course often large tissue defects occur, so that a long-term stable defect reconstruction plays a
crucial role after any successful debridement. The reconstruction can include split skin grafting or local and free flaps.
Here we present a case of a 41-year-old male patient with a NF in the trochanter major region after spondylodesis and
spinal cord stimulation (SCS) device implantation. After multiple operations including local and free flaps we performed
a defect reconstruction using an arteriovenous (AV) loop and subsequent free latissimus dorsi transplantation leading
to no further operations. This complex reconstruction can be considered as the final stage of any reconstruction latter.

Keywords: Necrotizing fasciitis, arteriovenous loop, free latissimus dorsi flap transplantation

INTRODUCTION
[1,2]
Necrotizing fasciitis (NF) is a rare and severe infection caused by different kinds of bacteria . The first and
most important therapy is a radical debridement of all infected tissue leading to large soft tissue defects.
Mostly, these tissue defects can be reconstructed using split skin grafts, but in areas of joints or when other
structures like bone, vessels or nerves are exposed, defect coverage using local or free flaps is required. In the

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net