FIG. 6-67. The flap is sutured into place. The posterior tibial nerve defect was repaired with multiple interpositional sural nerve grafts.
FIG. 6-68. X ray shows the underlying fracture healed, with a sliding bone graft performed as a secondary procedure after control of the local osteomyelitis by the vascularized cover.
FIG. 6-69. Late view of flap. Protective sensation was restored to the sole of the foot.
FIG. 6-70. The patient is shown standing with a well-healed, solid tibia. The soft-tissue defect on the right anterior thigh represents the donor defect of the unsuccessful classic cross-over flap used primarily.
FIG. 6-71. The linear donor scar of the groin flap is aesthetically more acceptable. This case illustrates the frequent use of a microvascular transplant to salvage a failed "classical" or myocutaneous flap.
A lesion of the calf was produced by the excision of a melanoma.
FIG. 6-72. The skin graft was fixed to the underlying fascia and muscle.
FIG. 6-73. A groin flap was inserted in an upside-down fashion, anastomosing vessels from the flap to the underlying posterior tibial vessels in an end-to-side fashion.
FIG. 6-74. The calf view from the posterior view has good restoration of soft tissue gliding cover, contour, and color.
1. McLean, D.H., and Buncke, H.J.: Autotransplant of omentum to a large scalp defect with microsurgical revascularization. Plast. Reconstr. Surg. 49:266, 1972.
2. Daniel, R.K., and Taylor, G.I.: Distant transfer of an island flap by microvascular anastomosis. Plast. Reconstr. Surg. 52:111, 1973.
3. Milton, S.M.: The effect of delay on survival of experimental pedicle skin flap. Br. J. Plast. Surg. 22:244, 1969.
4. Goldwyn, R.W., Lamb, D.L., and White, W.L.: An experimental study of large island flaps in dogs. Plast. Reconstr. Surg. 31:528, 1963.