title: Use of latissimus dorsi flap pedicle as a T-junction to facilitate simultaneous free fibular flap inset in lower extremity salvage.
abstract: Marjolin's ulcer is a very aggressive form of squamous cell carcinoma arising from chronic wounds or unstable scars. A resection margin of at least 2 cm with clear deep margin is required on removal. A 79-year-old male presented with chronic osteomyelitis of the left anterior tibial region with chronic ulceration. Biopsy revealed squamous cell carcinoma. The tumour, measuring 8 cm, was resected with surrounding unstable scar tissue including en bloc resection of the involved tibial bone, leaving the posterior cortex. Reconstruction was done with a fibular free flap from the contralateral side, but the pedicle length was too short to reach the anterior tibial vessels. To bridge the vascular gap, and to cover the soft-tissue defect, a latissimus dorsi free flap was harvested using the muscle-sparing method. The thoracodorsal vessels were used as an interpositional graft to anastomose the peroneal vessels of the fibular flap. The patient was ambulatory by 4 months, and complete bone union was seen after 6 months. During the 18-month follow-up period, there was no evidence of recurrence.
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.forename: Seungki
authors.initials: S
authors.lastname: Youn
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Siew-Weng
authors.initials: SW
authors.lastname: Ng
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D007866:Leg; D008297:Male; D010019:Osteomyelitis / Q000150:complications; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps; D013977:Tibia