title: Reconstruction of Extensive Soft-Tissue Defects with Concomitant Bone Defects in the Lower Extremity with the Latissimus Dorsi-Serratus Anterior-Rib Free Flap.
abstract: BACKGROUND
  The combined latissimus dorsi-serratus anterior-rib (LD-SA-rib) free flap provides a large soft-tissue flap with a vascularized bone flap through a solitary vascular pedicle in a one-stage reconstruction.
  
  
  METHODS
  Seven LD-SA-rib free flaps were performed in seven patients to reconstruct concomitant bone and extensive soft-tissue defects in the lower extremity (tibia, five; femur, one; foot, one). The patients were all male, with an average age of 34 years (range, 20-48 years). These defects were secondary to trauma in five patients and posttraumatic osteomyelitis in two patients.
  
  
  RESULTS
  All flaps survived and achieved bony union. The average time to bony union was 9.4 months. Bone hypertrophy of at least 20% occurred in all flaps. All patients achieved full weight-bearing ambulation without aid at an average duration of 23.7 months. Two patients developed stress fractures of the rib flap. There was no significant donor site morbidity, except for two patients who had pleural tears during harvesting of the flap.
  
  
  CONCLUSIONS
  The LD-SA-rib flap provides a large soft-tissue component and a vascularized bone flap for reconstruction of composite large soft-tissue defects with concomitant bone defects of the lower extremity in a one-stage procedure.
authors.affiliation: Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Wei Tee
authors.initials: WT
authors.lastname: Sia
authors.affiliation: Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
authors.forename: Germaine Guiqin
authors.initials: GG
authors.lastname: Xu
authors.affiliation: Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
authors.forename: Mark Edward
authors.initials: ME
authors.lastname: Puhaindran
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors.forename: Bien Keem
authors.initials: BK
authors.lastname: Tan
authors.affiliation: Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Mathew Hern Wang
authors.initials: MH
authors.lastname: Cheng
authors.affiliation: Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Winston Yoon Chong
authors.initials: WY
authors.lastname: Chew
mesh_terms: D000328:Adult; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D010521:Periosteum / Q000098:blood supply; D011859:Radiography; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D016474:Weight-Bearing; D055815:Young Adult