Reconstruction of a large upper tibial wound extending to the knee with a free latissimus dorsi flap: Optimizing the outcomes.

Despite recent advances in free tissue transfer, management of a large upper tibial wound extending to the knee can be challenging for reconstructive surgeons. In this report, we present two cases where a free latissimus dorsi flap was used for successful soft-tissue coverage of the wound for limb salvage with optimal reconstructive outcomes. Our unique recipient vessel selection allows more effective free-tissue transfer without using a vein graft. Our preferred flap inset technique with multiple interrupted horizontal mattress sutures over a closed suction drain leads to an improvement of the initial contour of soft-tissue coverage that may contribute to the final optimized outcome in the lower-extremity reconstruction with or without a further debulking procedure. (c) 2007 Wiley-Liss, Inc.