Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: a case report

Free muscular, osteomuscular, and fasciocutaneous flaps are widely used for midfoot reconstruction. The latissimus dorsi (LD) flap is rich in muscle mass, but the weight-bearing ability of the reconstruction with its combination with a scapula or rib has not been evaluated. Here, we report a case of reconstruction of the right midfoot with the trauma-related osteomyelitis using a free chimeric scapula and LD muscle flap in a 59-year-old woman with diabetes mellitus. After radical debridement and sequestrectomy, a 7 × 3 cm(2) wound with a 5 × 3 cm(2) bony defect was reconstructed with the chimeric scapula and LD muscle flap. The postoperative course was uneventful. The bony union was achieved 6 months after surgery. In 14 months follow-up, no clinical complications including a new ulcer or stress fracture were noted. At the end of follow-up, the gait analysis showed an unbalanced stress distribution on the right foot and a valgus gait. We suggest that this chimeric scapula and LD muscle flap may be an alternative option for midfoot reconstruction.