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 FIG. 19-95. Preoperative x ray shows chronic infective changes.
 FIG. 19-96. Multiple wide debridements of infected bone involving the entire anterior cortex of the tibia. A latissimus muscle was placed in the marrow defect, much as a hot dog is placed in a bun, then covered with a mesh graft.
 FIG. 19-97. Healed wound, infection controlled.
 FIG. 19-98. The patient went on to solid bony union and hypertrophy and has returned to ranching.
CASE 16
A young girl sustained a severe compound comminuted fracture with loss of 10 cm of the tibia and of overlying soft tissue, secondary to a motorboat propeller accident. (FIGs. 19-99 through 19-105 from Gordon, L., Buncke, H.J., Alpert, B.S.: Free latissimus dorsi muscle flap with split-thickness skin graft cover: A report of 16 cases. Plast. Reconstr. Surg. 70:173, 1982.)
 FIG. 19-99. Extent of injury.
 FIG. 19-100. Initial x rays (above) and after stabilization (below).
 FIG. 19-101. Appearance of the wound at 7 days, after multiple debridements. The massive wound now required protective cover.
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 FIG. 19-102. The entire latissimus is taken to provide the needed rich vascular cover.
 FIG. 19-103. The latissimus is ready to be dropped into the defect.
 FIG. 19-104. The muscle is sutured into the traumatic defect and fanned out under the wound margins. The vessels from the latissimus are anastomosed to the anterior tibial vessels proximally.
 FIG. 19-105. The appearance of the leg at 3 months. The mesh graft is well healed. A fibula was used to bridge the tibial defect.
 FIG. 19-106. X rays. The fibular graft fractured proximally but healed with additional casting. Left, PA of fracture and healed hypertrophied graft. Right, Lateral view of fracture and healing.
CASE 17
A 19-year-old man suffered a devascularizing, near-complete foot amputation in a motorcycle accident.
 FIG. 19-107. Appearance of injury.
 FIG. 19-108. The preoperative x ray dramatically demonstrates the extent of injury.
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