title: Reconstruction of extensive lower limb defects with thoracodorsal axis chimeric flaps.
abstract: BACKGROUND
  Extensive defects of the lower extremities are usually reconstructed with microvascular free flaps because of inadequate local tissues and wound complexity. Many attempts have been made to reconstruct such defects using the chimeric flap concept, enabling flaps with larger surface areas to be used while maintaining economical tissue use. The latissimus dorsi chimeric flap is one of the most useful tools for resurfacing extensive limb defects.
  
  
  METHODS
  Twelve patients with extensive lower leg defects underwent reconstruction with latissimus dorsi chimeric flaps between January of 2008 and March of 2012. A skin flap based on the cutaneous perforators, a latissimus dorsi muscle flap based on the muscular branches, and a serratus anterior muscle flap based on the branch from the thoracodorsal artery were harvested accordingly; the flap design depended on the dimensions and characteristics of the defect.
  
  
  RESULTS
  A total of 12 chimeric flaps were harvested and used, with the average surface area, including skin and muscle components, being 614 cm. The mean surface area of the skin flaps used was 355.6 cm. The mean area of the latissimus dorsi muscle flap was approximately 228 cm, and the surface areas of the three serratus anterior flaps used were 56 cm, 70 cm, and 180 cm. Flaps survived in all cases. Primary closure was used for all of the donor sites except one, and there was minimal donor-site morbidity.
  
  
  CONCLUSIONS
  The authors' results show that the latissimus dorsi chimeric free flap is a useful and versatile reconstructive option for extensive defects of the lower extremities.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Seoul, Republic of Korea From the Department of Plastic and Reconstructive Surgery, The Catholic University of Korea; and the Departments of Orthopedic Surgery and Plastic and Reconstructive Surgery, College of Medicine, Hanyang University.
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
authors.forename: Seungki
authors.initials: S
authors.lastname: Youn
authors.forename: Jong Do
authors.initials: JD
authors.lastname: Kim
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D018183:Transplantation Chimera; D014945:Wound Healing / Q000502:physiology*
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