Page 32 - PlasticosVol4

V O L 4 2019 I S S U E

5) Duraplasty was done using a Fascia Lata graft
with flap cover on top. It went onto heal in one
go without CSF leak or any further infection.

The whole defect was covered using a Free ALT
flap (perforator based with minimal muscle
harvested) and anastomosis done accordingly
with superficial temporal artery and vein (1
artery and 1 vein anastomosis) end to end using
10-0 Ethilon under a surgical microscope.

It survived well and there was no CSF leakage
as well. Considering her age and the gruesome
defect, the old lady recovered pretty quick and
went onto heal well.

Covering nearly her whole scalp!! The Message:

The Challenges: 1) Plan well.
2) Reconstruct structure by structure.
1) She was quite frail and aged for such a major 3) Don’t be afraid to do major Microvascular
surgery. flaps in the elderly. Although she too had
atherosclerosed vessels, it did very well.
2) Very large defect even for a single flap with 4) One good perforator in the flap and 1 artery
directly exposed brain. - 1 good vein anastomosis will make your flap
survive very well, irrespective of the size of the
3) The recipient vessels on dissection were flap.
found to be atheroscerosed. The blood flow
in and out of the flap on clamp release was
satisfactory and continued to remain so even
post op and she went onto heal well.

4) 1 artery and 1 vein were anastomosed here.
We went up quite proximally during ALT
flap harvest so that the vessel size becomes
sizeable and we get one large vein. Both were
anastomosed end to end with the Superficial
Temporal Artery and Vein.

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