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Reconstruction of Complex Post-Traumatic Perineal/Pelvic Defects Using a Pedicled Anterolateral Thigh Flap in a Child

Nthumba P, Hansen E, Jami M, Muchiri A, Nyoro P

AIC Kijabe Hospital

Correspondence to: Dr. Peter Nthumba, P. O Box 20 Kijabe 00220, Kenya. Email: nthumba@gmail.com

 

Summary

The complexity of the female pelvis and perineum becomes evident when traumatic or surgical defects need to be reconstructed; consideration should be given to the restoration or preservation of the most important functions subserved by this anatomic region. We used a composite pedicled fasciocutaneous anterolateral thigh flap with an innervated vastus lateralis muscle to reconstruct the pelvic ring, vagina, clitoris, labia and mons pubis.

 

CASE REPORT

Unaided ambulation, urinary and anal continence were successfully restored. An appropriately designed pedicled ALT flap can be successfully used to achieve excellent pelvic/perineal reconstruction and functional restoration in complex pelvic/ perineal defects, even in children.

Key Words: Trauma, Perineum, Pedicled ALT, Reconstruction

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Introduction

The anatomy of the female perineum and pelvis and the functions of these structures are highly complex. This normal anatomy is difficult to restore following extensive disruption of any kind (usually following trauma or oncologic resection) while aesthetic reconstruction may be feasible, functional restoration is a much more difficult goal. This anatomic region is host to the urethra, vagina and anus, the pelvis and the hip joints (responsible for weight transmission and ambulation). We present a case report of a 10 year old child who sustained severe injuries to her pelvis and perineum following a motor vehicle accident; her complex defect was successfully reconstructed with the use of a pedicled anterolateral thigh flap that included fascia and innervated vastus lateralis muscle.

Case Presentation

A 10 year-old girl who had sustained severe injuries to her pelvis and perineum was referred to our facility after one week of treatment in another hospital. A sigmoid colostomy and a suprapubic cystostomy were used to divert stool and urine, respectively. An initial evaluation under anesthesia found an infected degloving injury of the mons pubis, and a fracture and complete disruption of the pelvic