Multiple free dorsal flaps for symmetrical peripheral gangrene of the extremities: A case report

We present a case of symmetrical peripheral gangrene of the extremities due to acute infectious purpura fulminans that was reconstructed with four free flaps harvested from the bilateral backs. We reconstructed the right and left, upper and lower limbs using the parascapular flap and latissimus dorsi muscle flap from one side and the scapular flap and thoracodorsal artery perforator flap from the other side, in multiple stages. All four flaps survived, preserving the right and left heels and function of the bilateral wrist joints. Although there have been several reports of single-stage elevation of the combined scapular and latissimus dorsi flaps, there has been no report of multi-stage elevations of these flaps. When multiple flaps are required in multi-stage, raising the flaps based on the thoracodorsal artery and scapular circumflex artery from the ipsilateral back is a useful method because it does not require additional donor sites.