Significant soft-tissue defects in the lower extremity including the tibia and the foot are best managed with free skin-muscle of skin-grafted free muscle transfers.
While free flap donor sites useful for lower extremity reconstruction include the latissimus dorsi, the rectus abdominis, the gracilis, and the scapular flaps, the latissimus dorsi seems ideal. This muscle has a reliably long vascular pedicle of wide diameter, making microsurgical anastomosis of the thoracodorsal vessels straightforward. Because it is so large, it can cover virtually any size defect.
Furthermore, its flat configuration makes it especially easy to fold on itself so that it can be used to closure wounds with complex three-dimensional geometry and dead space. Although the gracilis and rectus abdominis muscles have their roles, in most cases the latissimus dorsi should serve well.
We described technical considerations in each case and the advantages of free latissimus dorsi myocutaneous flap on the reconstruction of the soft tissue defect in the lower extremity.
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