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DOI: 10.1055/s-0033-1361929
Chimeric Functional Latissimus Flap Transfer to Restore Ankle Dorsiflexion following a Traumatic Defect of the Lower Leg: A Case Report
Publikationsverlauf
01. Oktober 2013
17. Oktober 2013
Publikationsdatum:
07. Januar 2014 (online)
![](https://www.thieme-connect.de/media/jrm/201404/lookinside/thumbnails/10.1055-s-0033-1361929-1.jpg)
The reconstructive challenges to a devastating lower extremity injury include achieving bony stability, soft tissue coverage, restoring or improving function, and eventually achieving skin closure. Techniques including vascularized and nonvascularized bone grafting are well-described approaches in attaining bony stability of the lower extremity.[1] Free composite tissue transfer can achieve coverage of bony prosthetic material with healthy wound healing, but often fails to address the functional aspect of the lower limb. Functional restoration of the lower extremity has been shown to increase patient quality of life and may reach comparable levels to that of the normal population.[2] Cost-utility analysis shows that costs of amputation far exceed limb salvage independent of ongoing prosthesis needs.[3] Although this may prove to be a difficult task, encouraging results are seen with functional muscle transfer.[4] [5] [6] [7] Recently, the chimeric flap has gained popularity in its unique ability to restore composite defects of the lower extremity while maintaining economic tissue use and low donor-site morbidity. We present a case of a large composite defect of the anterior leg successfully repaired with a free chimeric functional latissimus dorsi flap resulting in functional dorsiflexion that has not previously been reported.
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References
- 1 Yazar S, Lin C-H, Wei F-C. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 2004; 114 (6) 1457-1466
- 2 Patel KM, Economides JM, Franklin B, Sosin M, Attinger C, Ducic I. Correlating patient-reported outcomes and ambulation success following microsurgical lower extremity reconstruction in comorbid patients. Microsurgery 2013; ; in press
- 3 Chung KC, Saddawi-Konefka D, Haase SC, Kaul G. A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures. Plast Reconstr Surg 2009; 124 (6) 1965-1973
- 4 Hallock GG. Restoration of quadriceps femoris function with a dynamic microsurgical free latissimus dorsi muscle transfer. Ann Plast Surg 2004; 52 (1) 89-92
- 5 Lin CH, Lin YT, Yeh JT, Chen CT. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg 2007; 119 (7) 2118-2126
- 6 Wechselberger G, Pichler M, Pülzl P, Schoeller T. Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome. Microsurgery 2004; 24 (6) 437-441
- 7 Kobayashi S, Sekiguchi J, Sakai Y, Ohmori K. Functioning free muscle transplantation to the lower leg. J Reconstr Microsurg 1995; 11 (5) 319-325
- 8 Yeap JS, Singh D, Birch R. A method for evaluating the results of tendon transfers for foot drop. Clin Orthop Relat Res 2001; 383 (383) 208-213
- 9 Tachi M, Toriyabe S, Imai Y, Takeda A, Hirabayashi S, Sekiguchi J. Versatility of chimeric flap based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap in reconstructing lower-extremity bone defects due to osteomyelitis. J Reconstr Microsurg 2010; 26 (6) 417-424
- 10 Kim SW, Youn S, Kim JD, Kim JT, Hwang KT, Kim YH. Reconstruction of extensive lower limb defects with thoracodorsal axis chimeric flaps. Plast Reconstr Surg 2013; 132 (2) 470-479