Use of thigh-based recipient vessels for free flap reconstruction in gustilo anderson type IIIC lower extremity open fractures: Description of two cases
- 1Corresponding author.
- 2Plastics, Reconstructive and Aesthetics Surgery Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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.
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BibTeX
@article{zeng2026thighbased,
title = {{Use of thigh-based recipient vessels for free flap reconstruction in gustilo anderson type IIIC lower extremity open fractures: Description of two cases}},
author = {Faith Ai Ping Zeng and Sally Shin Jie Chan and Yijun Wu and Jolie Jingyi Hwee},
journal = {JPRAS Open},
year = {2026},
month = sep,
doi = {10.1016/j.jpra.2026.09.033},
url = {https://doi.org/10.1016/j.jpra.2026.09.033},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Use of thigh-based recipient vessels for free flap reconstruction in gustilo anderson type IIIC lower extremity open fractures: Description of two cases
AU - Faith Ai Ping Zeng
AU - Sally Shin Jie Chan
AU - Yijun Wu
AU - Jolie Jingyi Hwee
PY - 2026
DA - 2026/09/30
JO - JPRAS Open
DO - 10.1016/j.jpra.2026.09.033
UR - https://doi.org/10.1016/j.jpra.2026.09.033
AB - 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.
SN - 2352-5878
ER -