The free latissimus dorsi flap as primary free flap and crane flap with secondary pedicled transfer.

We are reporting a case of a 43-year-old woman, who developed a soft tissue defect of the knee region following complex lower limb trauma. The defect was covered with a microvascular latissimus dorsi (LD) flap. The patient required a total knee replacement and developed a defect at the anterior aspect of the knee.

Influence of transendothelial mechanisms on microcirculation: consequences for reperfusion injury after free flap transfer. Previous, current, and future aspects.

The success of a free microvascular tissue transfer is based on a sufficient microanastomosis which meets the following requirements: a pedicle placed without kinking or twisting, good drainage, a well-defined recipient vessel, integrity of the endothelium, and duration of ischemia. The extent of skin and muscle necrosis increases significantly with increases in ischemia time. Reperfusion of ischemic tissue results in local and systemic damage associated with the release of oxygen free radicals, polymorphonuclear leucocytes, and such endothelial hormones as endothelin-1, EDRF (endothelial-derived relaxing factor), thromboxane, complement, and cytokines.

Use of soleus muscle flaps for coverage of distal third tibial defects.

The authors reviewed the outcome of 12 patients who underwent soleus flap reconstruction of distal third lower extremity defects. Nine of the 12 patients achieved a healed, stable wound; however, several flaps and multiple additional procedures were often required. One of the 12 patients experienced soleus flap loss and two of the patients required below-knee amputations.