title: Reconstruction of Complex Defects of Lower Extremities Using Thinned Free Muscle Flaps.
abstract: BACKGROUND
  Bulky appearance is a major shortcoming after surface coverage using free muscle flaps. The one-stage thinning procedure at the time of transfer can improve the appearance and avoid additional debulking surgery. We present our experiences in the reconstruction of complex lower extremity defects using thinned free muscle flaps.
  
  
  METHODS
  Latissimus dorsi muscle flaps (LDMs) and rectus abdominis muscle flaps (RAMs), which have vessel pedicles running deep in the muscles, were raised and the superficial tissue layers were removed to thin the flaps. These thinned muscle flaps were then used to resurface the wounds on lower extremities followed by coverage of skin autografts on the muscle surfaces.
  
  
  RESULTS
  Fourteen LDMs and four RAMs were thinned used for resurfacing eight, five, and three defects on feet, ankles, and pretibial regions, respectively, with wounds that ranged from 6 × 4 cm(2) to 23 × 9 cm(2). All muscle flaps survived the tangential thinning procedures uneventfully. High take rates were observed for most skin grafts, except that a partial skin loss was found in one case. During the 1-20 months follow-up, the skin surface contours over the thinned muscle flaps matched well with adjacent areas.
  
  
  CONCLUSIONS
  Intraoperative immediate thinning of LDMs and RAMs can be safely accomplished during the primary reconstruction procedure and may provide an alternative for coverage of complex lower extremity defects.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 17 Changle Western Road, Xi'an, Shaanxi, China. gongyanrong@163.com.
authors.forename: Baoqiang
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 17 Changle Western Road, Xi'an, Shaanxi, China.
authors.forename: Jianwu
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Plastic Surgery, 301 Military Hospital of China, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 17 Changle Western Road, Xi'an, Shaanxi, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 17 Changle Western Road, Xi'an, Shaanxi, China.
authors.forename: Yingjun
authors.initials: Y
authors.lastname: Su
authors.affiliation: Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 17 Changle Western Road, Xi'an, Shaanxi, China.
authors.forename: Shuzhong
authors.initials: S
authors.lastname: Guo
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery / Q000637:transplantation*; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D018409:Foot Injuries / Q000175:diagnosis / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D064171:Superficial Back Muscles / Q000601:surgery* / Q000637:transplantation; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Latissimus dorsi muscle flap; Lower extremity injury; Muscle flap debulking; Rectus abdominis muscle flap; Thin flap