title: [Osteomyocutaneous latissimus dorsi scapular combined flap with vascularized rib to repair the large defect of tibia].
abstract: OBJECTIVE
  To design a combined flap of subscapular axis including vascularized lateral scapular, rib and latissimus dorsi to repair the large defect of tibia.
  
  
  METHODS
  The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibia after primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm x 6 cm scar involved the proximal medial segment of tibia. After resection of scar and fibular tissue over the bone defect floor, a latissimus dorsi myocutaneous flap 14 cm x 5 cm pedicled with subscapular artery-thoracodorsal artery, a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared. The tibialis posterior and saphenous vein were used for anastomosis. A proximal anatomic plate was applied to the fixation of tibia.
  
  
  RESULTS
  The compound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation.
  
  
  CONCLUSIONS
  This combined flap is successful and can provide alternative to the resolution of large defect of tibia.
authors.affiliation: Department of Orthopaedic, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China. aiminchen64@yahoo.com.cn
authors.forename: Aimin
authors.initials: A
authors.lastname: Chen
authors.forename: Chunlin
authors.initials: C
authors.lastname: Hou
authors.forename: Yuezhong
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation; D012272:Ribs / Q000098:blood supply / Q000637:transplantation; D012540:Scapula / Q000637:transplantation; D013524:Surgical Flaps; D013977:Tibia / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome