Versatility of Chimeric Flap based on Thoracodorsal Vessels Incorporating Vascularized Scapular Bone and Latissimus Dorsi Myocutaneous Flap in Reconstructing Lower-extremity Bone Defects due to Osteomyelitis

Abstract

To treat lower-extremity osteomyelitis secondary to trauma, bone and soft tissue can be grafted at the same time using microsurgical techniques. We investigate the use of chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap to reconstruct bone and soft-tissue defects of the lower leg due to osteomyelitis. Ten patients with lower-extremity bone and soft-tissue defects due to osteomyelitis were treated. Vascularized scapular bones were raised on the angular branch of the thoracodorsal artery. Latissimus dorsi myocutaneous flaps were elevated simultaneously to reconstruct the soft tissue defects. All patients tolerated the procedure well. One patient developed an early venous thrombosis, which was successfully treated by thrombectomy. Mean follow-up time was 7 years and 8 months. Bone union without refracture was observed in all patients. The mean time required for bone union after surgery was 13.5 weeks. Donor-site morbidity was minimal. Chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous are safe and effective in the repair of lower-extremity bone and soft-tissue defects caused by osteomyelitis.