Plastic Division, Department of Surgery, Shin Kong Wo Ho-Su Memorial Hospital, Taiwan, Republic of China.
Microsurgery. 2012 Sep;32(6):485-8. doi: 10.1002/micr.22033. Epub 2012 Jul 18.
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 cm(2) wound with a 5 × 3 cm(2) 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.
游离肌皮瓣、骨肌皮瓣和筋膜皮瓣被广泛应用于中足重建。背阔肌（Latissimus dorsi，LD）皮瓣肌肉丰富，但与肩胛骨或肋骨联合重建的负重能力尚未得到评估。本文报道了 1 例 59 岁糖尿病女性创伤相关骨髓炎患者，采用游离嵌合肩胛骨和 LD 肌皮瓣进行右中足重建的病例。在彻底清创和病灶清除术后，采用 7×3cm(2)的嵌合肩胛骨和 LD 肌皮瓣修复 5×3cm(2)的骨缺损创面。术后过程顺利。术后 6 个月达到骨性愈合。随访 14 个月，未见新溃疡或应力性骨折等临床并发症。随访结束时，步态分析显示右脚受力分布不平衡，呈外八字步态。我们认为这种嵌合肩胛骨和 LD 肌皮瓣可能是中足重建的另一种选择。
