AV loop free flap: An interdisciplinary approach for perineal and sacral defect reconstruction after radical oncological exenteration and radiation in a colorectal cancer patient

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Background: The free flap transfer of a latissimus dorsi flap (LDF) for the closure of sacral wound defects after pelvic exenteration and radiation therapy offers a successful tool of the plastic surgeon. This case report shows the successful coverage using an upstream arterio-venous (AV) loop in combination with an LDF. Case presentation: We describe the case of a patient who underwent a pelvic exenteration and radiation therapy due to a local recurrence of rectal cancer. The initially used VRAM flap could not ensure a satisfactorily wound closure. An interdisciplinary approach first yielded an AV loop using both greater saphenous veins and was connected to the arteria and vena femoris followed by a free LDF transfer, which was performed 11 days later. The result was an excellent reconstructive and plastic coverage of the sacral wound defect with a well-perfused LDF. The long-term result showed a perfectly integrated flap in the sacral region. Conclusion: We recommend the free LDF for the coverage of large wound defects in irradiated areas after the failure of VRAM flap. If an AV loop is necessary within the flap transfer, we recommend conducting two procedures to guarantee the perfusion of the AV loop.


Original languageEnglish
Article number154
JournalWorld journal of surgical oncology
Issue number1
Publication statusPublished - 2 Sept 2019

External IDs

PubMed 31477142
ORCID /0000-0003-4633-2695/work/145698699


Sustainable Development Goals

ASJC Scopus subject areas


  • Arterio-venous loop, Free latissimus dorsi flap, Interdisciplinary approach, Local recurrence, Rectal cancer, Two-time approach