Compartment syndrome at the fibula flap's donor site and salvage by anerolateral thigh chimeric flap

Abstract

We report a challenging case of chimeric anterolateralthigh flap reconstruction to cover peroneus longus andcalcaneal tendons exposure as a consequence of a donorsite compartment syndrome after fibula flap harvesting.A 61-year-old patient was referred to the Maxillo-Fa-cial Unit for a squamous cell carcinoma (T4-N3-M0) ofthe buccal mucosa involving the inferior premolar alveo-lar ridge. The patient underwent right emi-mandibulec-tomy, tumor en-bloc excision, and bilateral radical neckdissection. An immediate reconstruction was performedwith a free osteocutaneous fibula flap with two differentskin paddles. The first one was used to reconstruct theskin defect and the second one to reconstruct the mucosaldefect. The donor site was closed by direct suture undertension. A suction drain was positioned.The initial postoperative period was uneventful. Onthe fifth postoperative day, the negative-pressure drainagewas pulled out. A week after surgery, the donor site wasedematous and dark brown fluid flowed from the wound.Only mild pain occurred with active or passive movementof the toes. During the second week after surgery, theswelling and dark fluid secretion from the donor sitebecame more obvious. A necrotic area appeared in thecontext of donor site closure; this area rapidly increasedits dimensions in a few days. The only clinical symptomstill was a mild pain. Two weeks from surgery, the clini-cal diagnosis was compartment syndrome, due to exces-sive tension.This compartment syndrome led to a large loss ofskin and muscles of the lateral compartment of the legwith peroneus longus tendon and part of calcaneal tendonexposure (Fig. 1), then the patient was referred to ourPlastic Surgery Unit in order to plan a repair.After a surgical debridement, a two week of VacuumAssisted Closure