[Repairing widespread traumatic soft tissue defects in lower limb with free latissimus dorsi muscle-skin flaps].

OBJECTIVE

To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps.

METHODS

From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscle-skin flaps; Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60 years, and the disease course was 2 hours to 2 months. The defect was by plough-machine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posterior of heel and leg, the defect area ranged from 21 cm x 12 cm to 35 cm x 15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cmX 14 cm and 30 cm x 21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by open infection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm x 14 cm to 33 cm x 24 cm. The donor sites were covered by large mid-thickness flap.

RESULTS

There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received two-stage plastic operation because bulky flaps bring some trouble in wearing shoes. In 5 cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication.

CONCLUSION

The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.