FIG. 19-109. Following revascularization and fracture reduction, a large soft-tissue defect including exposed tendon remains.

FIG. 19-110. X ray of pinned fracture.

FIG. 19-111. The latissimus flap is ready to cover the 270-degree circumferential defect and close the open ankle joint.

FIG. 19-112. Muscle is in place, folded to show extensor tendons.

FIG. 19-113. The flap inset into the dorsal foot is covered with a meshed graft.

FIG. 19-114. Early postoperative follow-up, with complete flap survival and restoration of the tibiotalar joint. The patient is now walking without support.

References

1. Maxwell, G.P., Steuber, K., and Hoopes, J.: A free latissimus dorsi musculocutaneous flap. Plast. Reconstr. Surg. 62:462, 1978.

2. Maxwell, G.P., Manson, P., and Hoopes, J.: Experience with thirteen latissimus dorsi myocutaneous free flaps. Plast. Reconstr. Surg. 64:1, 1979.

3. Godina, M.: Preferential use of end-to-side arterial anastomoses in freeflap transfers. Plast. Reconstr. Surg. 64:673, 1979.

4. Serafin, D., Sabatier, R., Morris, R., and Georgiade, N.: Reconstruction of the lower extremity with vascularized composite tissue: Improved tissue survival and specific indications. Plast. Reconstr. Surg. 66:230, 1980.

5. May, J.W., Gallico, G.G., and Lukash, F.N.: Microvascular transfer of free tissue for closure of bone wounds of the distal lower extremity. N. Engl. J. Med. 306:253, 1982.

6. Swartz, W.M., and Mears, D.C.: The role of free-tissue transfers in lower extremity reconstruction. Plast. Reconstr. Surg. 76:364, 1985.

7. May, J., Lukash, F., and Gallico, G.: Latissimus dorsi free muscle flap in lower extremity reconstruction. Plast. Reconstr. Surg. 68:603, 1981.

8. Gordon, L., Buncke, H.J., and Alpert, B.S.: Free latissimus dorsi muscle flap with split-thickness skin graft cover: Report of 165 cases. Plast. Reconstr. Surg. 70:173, 1982.

9. Wood, M.B., Cooney, W.P., and Irons, G.B.: Lower extremity salvage and reconstruction by free-tissue transfer. Analysis of results. Clin. Orthop. 201:151, 1985.

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