A 60-year-old Malay gentleman with no significant past medical history was presented to the orthopedic surgeon with left thigh swelling and increasing pain.
On examination, he had an indurated, large left thigh lump.
Upon further examination with an MRI scan, an ill-defined mass involving almost all the muscles of his anterior left thigh could be seen. A biopsy of the mass showed a high grade liposarcoma, and a surgery is needed to remove the cancer. This would involve the complete removal of all his anterior thigh muscles, which would have left him with a huge wound and unable to flex his left hip.
However, with this approach, his mobility would be largely affected and leave his independence compromised as he would have to rely on his family for some of his daily activities, not to mention a possible change or loss of his job.
He was then referred to
Dr Adrian by his orthopedic surgeon for the best reconstructive solution for this problem.
Together, they planned to resect the tumour and reconstruct the defect with simultaneous muscle and skin reconstruction with a pedicled gracilis muscle flap from the same thigh’s medial compartment, as well as a free anterolateral thigh (ALT) muscle and skin flap from the right thigh.
During the operation, the blood supply to the free ALT flap was re-established using intricate
microvascular surgery, the muscles from both flaps were sutured to recreate the anterior compartment muscles, the nerves from the 2 transferred muscle components were sutured to the remnant nerves of the left thigh to create 2 functional muscles, and the skin from the ALT flap was used to recreate the skin loss from the tumour resection.
This complex surgery is otherwise known as a neurotized muscle transfer.
Post-operatively, the patient made a good recovery from the operation and was discharged on just a knee brace. Over half a year, he underwent regular physiotherapy to improve the strength in his left thigh, and by his 6-month follow-up appointment, he was able to walk independently without walking aids.
The surgery allowed him a smooth return to his job, and most importantly, to care for himself totally and continue to enjoy a normal family life with his wife and two children.