Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 19:
Latissimus Dorsi Muscle Transplantation
  FIG. 19-68. To save the knee joint, latissimus transplant was used to resurface the degloved soft tissue over the joint anastomosing the muscle vessels and motor nerve to the popliteal vessels and peroneal nerve. Muscle is being draped over amputation stump.

FIG. 19-69. Stump is completely covered.

FIG. 19-70. Lateral view shows the nearly complete circumferential coverage.

FIG. 19-71. Follow-up at one year. Flexion.

FIG. 19-72. Extension.

FIG. 19-73. Maintenance below-knee length has permitted fitting with a below-knee prosthesis. The patient has returned to school and sports.

CASE, 12

A 42-year-old man suffered a popliteal injury and tibial plateau fracture when he fell off a bicycle.

FIG. 19-74. The postoperative course was complicated by vessel thrombosis, compartment syndrome, and muscle necrosis requiring fasciotomies and extensive muscle debridement of all three compartments.

FIG. 19-75. A combined latissimus-serratus muscle was transplanted to the leg, with the long pedicle anastomosed end-to-side to the proximal popliteal artery. The distal latissimus muscle and the serratus were pulled through the interosseous membrane to close the posterior compartment. Anterior view of leg with through-and-through defect.


FIG. 19-76. Combined serratus-latissimus next to wound.

FIG. 19-77. Ten-month follow-up shows anterior closure. The patient is ambulatory after correction of the small heel decubitus.

FIG. 19-78. Posterior closure.


The latissimus dorsi and gracilis muscles were used in sequence to cover a chronic compound comminuted plated fracture with circumferential loss of skin from the knee to the ankle. The patient has also suffered amputation of the opposite leg.

FIG. 19-79. Medial view of the wound with the central two-thirds of the tibia exposed.

FIG. 19-80. X ray shows stabilization with the plate.

FIG. 19-81. The large latissimus transplant is ready for draping over the debrided wound bone and metal plate.

FIG. 19-82. Complete healing of the circumferential skin-grafted wound except for the small area distally, exposing underlying tendons.

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