|| FIG. 18-08. Late follow-up. The patient has been ambulatory without recurrence of infection for 10 years.
An 86-year-old woman with cardiac problems developed an extensive ulcer of the lower anterior tibial region secondary to excision and subsequent radiation treatment of a recurrent melanoma. Amputation was considered.
FIG. 18-09. The chronic ulcer is shown with underlying exposed tendon and bone.
FIG. 18-10. The excisional defect and the gracilis muscle next to the wound.
FIG. 18-11. The gracilis muscle has been isolated on its pedicle.
FIG. 18-12. The gracilis was placed next to the excisional defect.
FIG. 18-13. Muscle was placed in the widely debrided wound. Vessels were repaired to the anterior tibials.
FIG. 18-14. The patient was standing and walking 1 month after surgery and still free of disease 2 years later. Because of her cardiac problems, the procedure was performed as quickly as possible-in 2 hours and 50 minutes.
The gracilis muscle was used to fill an old osteomyelitic cavity lined with a skin graft. The lining was unstable, particularly in warm weather after prolonged standing.
FIG. 18-15. View of the skin lining of the osteomyelitic cavity in the lower end of the tibia.
FIG. 18-16. X ray shows the extent of the cavity.
FIG. 18-17. Gracilis muscle next to the bony cavity after removal of the unstable split-thickness skin-graft lining.
FIG. 18-18. The muscle is "stuffed" into the cavity to obliterate 'all dead space'.
FIG. 18-19. Early postoperative follow-up.
FIG. 18-20. Appearance of the foot several months post-transplant. The split-thickness skin graft on the surface of the muscle has contracted, restoring contour and filling the underlying dead space. The patient is walking without problems.