Fascial Patch Reconstruction of a Gastric Conduit Defect Using an Anterolateral Thigh-Vastus Lateralis Composite Free Flap: A Case Report.
Fang-Wei Lin, Chen-Hsuan Yen, Yung-Chun Lin et al.
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Case in brief
A 71-year-old man with a retrosternal gastric conduit developed a full-thickness rupture during coronary artery bypass grafting through median sternotomy. Primary repair failed, with recurrent dehiscence and sternal wound infection. After debridement and partial resection of infected sternum and manubrium, a 3 × 2 cm noncircumferential conduit defect remained alongside presternal and mediastinal dead space. Reconstruction used an anterolateral thigh–vastus lateralis composite free flap: fascia patched the defect, muscle reinforced the repair and filled dead space, and a skin paddle covered the wound. There were no flap-related complications; imaging showed no leak, and oral feeding resumed.
What made this case unusual
The composite flap’s components were assigned distinct roles: a contiguous fascial extension formed a tension-free patch around the conduit defect, while vastus lateralis muscle reinforced it and filled dead space, and the skin paddle provided coverage and monitoring.
Diagnostic / clinical pearl
When a limited gastric conduit defect coexists with infected chest-wall tissue loss and dead space, component-specific composite free-flap reconstruction may provide both a fascial patch and vascularized reinforcement.