Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report

Free muscular, osteomuscular, and fasciocutaneous flaps are widely used for midfoot reconstruction. The latissimus dorsi (LD) flap is rich in muscle mass, but the weight‐bearing ability of the reconstruction with its combination with a scapula or rib has not been evaluated. Here, we report a case of reconstruction of the right midfoot with the trauma‐related osteomyelitis using a free chimeric scapula and LD muscle flap in a 59‐year‐old woman with diabetes mellitus. After radical debridement and sequestrectomy, a 7 × 3 cm2 wound with a 5 × 3 cm2 bony defect was reconstructed with the chimeric scapula and LD muscle flap. The postoperative course was uneventful. The bony union was achieved 6 months after surgery. In 14 months follow‐up, no clinical complications including a new ulcer or stress fracture were noted. At the end of follow‐up, the gait analysis showed an unbalanced stress distribution on the right foot and a valgus gait. We suggest that this chimeric scapula and LD muscle flap may be an alternative option for midfoot reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

[1]  A. Woo.  Foot and Ankle Reconstruction , 2014 .

[2]  C. Mierisch,et al.  Management of combined soft tissue and osseous defect of the midfoot with a free osteocutaneous radial forearm flap: a case report. , 2012, Journal of Foot and Ankle Surgery.

[3]  M. Topalan,et al.  Midfoot reconstruction with free vascularized fibular graft after wide resection: a case report. , 2011, Acta orthopaedica Belgica.

[4]  L. Oloff,et al.  Excision of Extensive Midfoot Pigmented Villonodular Synovitis With Microvascular Anastamosis of Iliac Crest Bone Graft Using External Fixation , 2011, Foot & ankle specialist.

[5]  L. Prantl,et al.  Outcome after complex trauma of the foot. , 2011, The Journal of trauma.

[6]  P. Jaminet,et al.  Reconstruction of the second metacarpal bone with a free vascularized scapular bone flap combined with nonvascularized free osteocartilagineous grafts from both second toes: A case report , 2011, Microsurgery.

[7]  Rahul Krishnarao Patil,et al.  Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft , 2011, Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India.

[8]  T. Saga,et al.  Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. , 2010, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[9]  M. Tachi,et al.  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. , 2010, Journal of reconstructive microsurgery.

[10]  B. Zeng,et al.  Peroneal artery perforator chimeric flap for reconstruction of composite defects in extremities , 2010, Microsurgery.

[11]  S. Hou,et al.  Vascularized Iliac Osteomuscular Free Flaps for Composite Soft Tissue and Bone Defects of the Lower Extremity , 2009, Annals of plastic surgery.

[12]  D. Baumann,et al.  Free Flap Reconstruction for Complex Lower Extremity Wounds , 2009 .

[13]  K. Blackwell,et al.  Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction. , 2007, Archives of otolaryngology--head & neck surgery.

[14]  M. Dominkus,et al.  Metatarsal reconstruction with use of free vascularized osteomyocutaneous fibular grafts following resection of malignant tumors of the midfoot. A series of six cases. , 2007, The Journal of bone and joint surgery. American volume.

[15]  A. Danino,et al.  Le lambeau ostéomusculaire de muscle latissimus dorsi avec bord latéral de scapula : étude anatomique et application clinique , 2007 .

[16]  G. Malka,et al.  [The osteomuscular latissimus dorsi scapula flap: anatomical study and 3 cases]. , 2007, Annales de chirurgie plastique et esthetique.

[17]  Yu-Te Lin,et al.  Outcome Comparison between Free Muscle and Free Fasciocutaneous Flaps for Reconstruction of Distal Third and Ankle Traumatic Open Tibial Fractures , 2006, Plastic and reconstructive surgery.

[18]  M. Dutoit,et al.  Dynamic foot-pressure measurement in the assessment of operatively treated clubfeet. , 2004, The Journal of bone and joint surgery. American volume.

[19]  I. Antal,et al.  Mid-foot reconstruction following involvement of five bones by giant cell tumor , 2000, Skeletal Radiology.

[20]  S. Hansen,et al.  Surgical Reconstruction of the Diabetic Foot: A Salvage Approach for Midfoot Collapse , 1996, Foot & ankle international.

[21]  F. Wei,et al.  Fibula Osteoseptocutaneous Flap for Reconstruction of Composite Mandibular Defects , 1994, Plastic and reconstructive surgery.

[22]  G. Hallock.  Simultaneous Transposition of Anterior Thigh Muscle and Fascia Flaps: An Introduction to the Chimera Flap Principle , 1991, Annals of plastic surgery.

[23]  M. S. Noordhoff,et al.  Fibular Osteoseptocutaneous Flap: Anatomic Study and Clinical Application , 1986, Plastic and reconstructive surgery.