Pre-expanded bipedicled deep inferior epigastric artery perforator (DIEP) flap for paediatric lower limb reconstruction

摘要

We would like to present a challenging case, successfully managed with a unique combination of operative strategies, relying on basic principles. A 16-year old Caucasian female with a large cutaneous neurofibroma on the right lower limb measuring 26 x 19 cm, presented for excision and reconstruction. A diagnosis of type 1 neurofibromatosis was made based on the presence of a large cutaneous neurofibroma, multiple typical neurofibromas, more than 6 large cafe-au-lait spots and iris hamartomas (Lisch nodules). She had no other previous medical history and no previous surgery. Due to the size of the defect and the need for a large pliable fasciocutaneous flap, a lower abdominal flap was planned, however the patient's low body mass index (BMI) and lack of abdominal tissue suggested that closure of the donor site would present a problem. Other reconstructive options entertained in this setting included an anterolateral thigh flap, although the donor site was considered sub-optimal, and other flaps such as the groin flap would not have spanned the defect. A pre-expanded, bipedicled free 'stacked' deep inferior epigastric artery (DIEP) flap was thus selected as the option of choice.