|| FIG. 19-83. The gracilis muscle was draped over the debrided distal wound.
FIG. 19-84. An end-to-end repair of the gracilis muscle to the anterior tibial vessels and venae comitantes was performed. The muscle was covered with a meshed skin graft.
FIG. 19-85. Two months later, drainage developed medially. The plate and screws were removed and the wound closed with a second gracilis.
FIG. 19-86. Complete wound closure and final control of infection.
FIG. 19-87. The patient is walking with a below-knee prosthesis on the right leg. Though prolonged, the case demonstrates the use of multiple microvascular transplants to salvage a severely injured extremity.
This patient had a high-voltage electrical burn of the left leg, involving skin, tendons, bone, and joint capsule. (From Hagan, K.F., Buncke, H.J., and Gonzalez, R.I: Free latissimus
dorsi muscle flap coverage of an electrical burn of the lower extremity. Plast. Reconstr. Surg. 69:125, 1982.)
FIG. 19-88. The appearance of the wound 3 days after injury.
|| FIG. 19-89. Wound appearance after deep, complete debridement of the eschar down to and including the outer cortex of bone, joint capsule, and extensor tendons.
FIG. 19-90. The massive latissimus muscle is completely mobilized. A 15 cm vascular pedicle was dissected proximally to the axillary vessels to permit a repair well above the level of injury in the leg.
FIG. 19-91. The latissimus muscle filled the defect, which covered two-thirds of the circumference of the lower leg.
FIG. 19-92. Meshed skin graft over muscle.
FIG. 19-93. The patient was standing one month after the operation. He was discharged from the hospital 5 weeks postoperatively, attesting to the efficacy of early radical debridement and muscle transplant closure of such wounds.
A 38-year-old man had an open tibial-fibular injury with osteomyelitis.
FIG. 19-94. The soft-tissue injury is extensive, and the distal tibia has been exposed for 6 weeks.