Two for one: salvage of bilateral lower extremities with a single free flap.

It is thought that free muscle flaps may remain dependent on their original pedicle for more than 1-year postoperation, particularly in the lower extremity of patients with peripheral vascular disease. We present the first case report of bilateral lower extremity salvage with a single rectus abdominis myocutaneous free flap by transecting the main pedicle. The pedicle of the free flap, going to the contralateral extremity, was safely divided at 6-weeks postoperation. A tourniquet was used to compress the pedicle at the division point to assess viability of the flap distal to the point of occlusion prior to transection of the flap.