A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap
Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal...
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doaj-56c554b24bfd4c7e8d962c37d62cc9682021-04-02T13:36:26ZengGeorg Thieme Verlag KGJournal of Reconstructive Microsurgery Open2377-08132377-08212018-07-010302e74e7710.1055/s-0038-1675410A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula FlapSatoshi Hayashi0Kenji Kawamura1Naoki Maegawa2Akito Nakanishi3Yasushi Mizutani4Akinori Okuda5Shinpei Kurata6Takamasa Shimizu7Tsutomu Kira8Shohei Omokawa9Yasuhito Tanaka10Department of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanDepartment of Orthopaedic Surgery, Nara Medical University, Nara, JapanAbstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675410osteocutaneous fibula flapdeep venous thrombosisperoneal vein |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Satoshi Hayashi Kenji Kawamura Naoki Maegawa Akito Nakanishi Yasushi Mizutani Akinori Okuda Shinpei Kurata Takamasa Shimizu Tsutomu Kira Shohei Omokawa Yasuhito Tanaka |
spellingShingle |
Satoshi Hayashi Kenji Kawamura Naoki Maegawa Akito Nakanishi Yasushi Mizutani Akinori Okuda Shinpei Kurata Takamasa Shimizu Tsutomu Kira Shohei Omokawa Yasuhito Tanaka A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap Journal of Reconstructive Microsurgery Open osteocutaneous fibula flap deep venous thrombosis peroneal vein |
author_facet |
Satoshi Hayashi Kenji Kawamura Naoki Maegawa Akito Nakanishi Yasushi Mizutani Akinori Okuda Shinpei Kurata Takamasa Shimizu Tsutomu Kira Shohei Omokawa Yasuhito Tanaka |
author_sort |
Satoshi Hayashi |
title |
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap |
title_short |
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap |
title_full |
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap |
title_fullStr |
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap |
title_full_unstemmed |
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap |
title_sort |
rare case of pre-existing deep venous thrombosis in the peroneal vein of a free osteocutaneous fibula flap |
publisher |
Georg Thieme Verlag KG |
series |
Journal of Reconstructive Microsurgery Open |
issn |
2377-0813 2377-0821 |
publishDate |
2018-07-01 |
description |
Abstract
Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported.
Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery.
Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients. |
topic |
osteocutaneous fibula flap deep venous thrombosis peroneal vein |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675410 |
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