Reconstruction of a lateral thigh defect with a transverse rectus abdominis myocutaneous (TRAM) free flap: A case report

INTRODUCTION

Despite advancements in reconstructive surgery, the repair of large thigh deformities remains challenging. When other options are not feasible, distant flaps become necessary. Successful repairs have been achieved using a transverse rectus abdominis myocutaneous (TRAM) flap for the chest wall, groin, abdominal wall, sternum, and breast.

CASE PRESENTATION

This study presents the case of a 40-year-old man who experienced a large deformity, measuring 20 cm ∗ 10 cm in his left lateral thigh resulting from a road accident that occurred a decade ago. Additionally, he developed osteomyelitis due to exposed bone based on MRI and clinical signs. To address this large defect, a free TRAM flap was utilized, effectively covering the area with a well-vascularized skin graft. This approach eliminated the need for a latissimus flap with a skin graft.

DISCUSSION

In cases of covering large thigh defects, a variety of flaps can also be considered. The latissimus dorsi muscle is mainly used as a free flap, but surgeons should be cautious regarding the use of the latissimus dorsi flap while this flap is an attractive option in many other parts of the body, it's functional loss must be carefully weighed in lower extremity patients who are often crutch- and/or wheelchair-dependent.

CONCLUSION

Based on this experience, the free-TRAM flap has proven to be a highly resilient option for similar defects and ranks among our top choices. It is important to note that in cases of infected and traumatic wounds where fatty tissue is undesirable, the flap may not be the best solution.

Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps

Patients diagnosed with breast cancer may opt to undergo surgical reconstructive flaps at the time of or after mastectomies. These surgeries leave patients with significant postoperative pain and sometimes involve large surgical beds including graft sites from the abdomen to reconstruct the breast. Consequently, multimodal methods of pain management have become highly favored. Quadratus lumborum catheters offer an opioid-sparing technique that can be performed easily and safely. We present a case of a patient who underwent a breast flap reconstruction and had bilateral quadratus lumborum catheters placed for perioperative pain control.