Work

Use of thigh-based recipient vessels for free flap reconstruction in gustilo anderson type IIIC lower extremity open fractures: Description of two cases

Year: 2026

Type: article

Abstract: Background: Free tissue transfer is central to reconstruction of Gustilo IIIC lower-extremity injuries, but recipient vessel selection is challenging when local vasculature is compromised. We describe two Gustilo IIIC injuries reconstructed using thigh-based recipient vessels. Case Presentations: Case 1: A 50-year-old man sustained an open tibial fracture with popliteal artery thrombosis and extensive tibial vessel injury. Following revascularization and serial debridement, a 25 × 15 cm tibial defect was reconstructed with a contralateral anterolateral thigh (ALT) free flap to the descending genicular artery (DGA), using an interposition great saphenous vein graft. The flap survived without complication.Case 2: A 35-year-old man sustained an open tibial fracture with complete popliteal artery transection requiring vascular reconstruction. A 20 × 14 cm defect was initially reconstructed with a free latissimus dorsi flap to the DGA using an interposition vein graft, complicated by venous thrombosis and flap loss. Subsequent reconstruction with an ALT flap and radial forearm flow-through flap to the superficial femoral vessels (SFA) achieved successful soft-tissue coverage. Discussion: The DGA provides an accessible recipient outside the primary zone of injury, with consistent anatomy and suitable calibre for microsurgical anastomosis. Its location facilitates a two-team approach, avoids popliteal fossa exploration, and may reduce interference with subsequent skeletal procedures. The SFA is a valuable alternative recipient vessel, offering robust and reliable inflow with a good arterial pressure head. Conclusion: Thigh-based recipient vessels, particularly the DGA and SFA, should be considered in severe lower-limb trauma when conventional below-knee recipient vessels are unavailable or compromised.

Source: JPRAS Open

DOI: 10.1016/j.jpra.2026.09.033

Authors: Faith Ai Ping Zeng, Sally Shin Jie Chan, Yijun Wu, Jolie Jingyi Hwee

Institution: Khoo Teck Puat Hospital

Language: English

Topic: Reconstructive Surgery and Microvascular Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,920