FIG. 19-68

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.

CASE 13

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.

next page...