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 FIG. 19-55. X ray shows preservation of useful structures.
 FIG. 19-56. The residual thumb has preserved some function.
CASE 9
A 63-year-old man developed wound dehiscence and a chronic infection in an upper abdominal incision.
 FIG. 19-57. The wound included necrosis of both superior rectus muscles.
 FIG. 19-58. A latissimus with a central skin island was prepared for transplantation.
 FIG. 19-59. Following wide debridement, the free latissimus flap was used to close the wound, anastomosing the thoracodorsal vessels to the deep inferior epigastric vessels.
 FIG. 19-60. Early postoperative view. Unfortunately, the patient developed pulmonary problems and died 4 weeks after surgery.
CASE 10
A patient had an open, pseudomonas-infected knee injury following a motor vehicle accident.
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 FIG. 19-61. Infected knee.
 FIG. 19-62. The preoperative open reduction and internal fixation (ORIF) has restored the condylar width, but closure has broken down, resulting in an open infected joint. X ray of knee.
 FIG. 19-63. The latissimus flap is elevated to provide coverage after debridement. The hardware was kept in place to preserve knee stability.
 FIG. 19-64. Postoperative follow-up at 14 months shows excellent contour without recurrence of infection. Extension.
 FIG. 19-65. Flexion.
CASE 11
An 11-year-old boy suffered crush injuries to both legs when he was struck by a car while sitting on the tailgate of a parked truck.
 FIG. 19-66. There was a nonreplantable, degloving amputation of the right leg, just distal to the knee.
 FIG. 19-67. The left femur was also fractured.
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