Limb salvage after fulminant septicemia using a free latissimus dorsi cross-leg flap

A 15-year-old boy survived fulminant meningococcal septicemia, with extensive tissue necrosis involving the face and the right arm, complicated by peripheral gangrene of the fingers on both hands and the distal parts of the feet. Although still often fatal, the mortality of fulminant septicemia has dropped substantially in the past decades, leading to more survivors, and requiring concurrent reconstruction of all extremities. This report discusses the advantages of using a single, free, latissimus dorsi (LD) myocutaneous cross-leg flap to salvage both feet, and the use of pedicled groin flaps bilaterally for coverage of fingers and hands, as illustrated by this case.