The latissimus dorsi/scapular bone flap (the "latissimus/bone flap")

During the past 4 years, our trauma and reconstructive service has treated a number of patients with lower extremity trauma involving the loss of both soft tissue and significant segments of tibia. While there are many methods for reconstruction of such defects, we became interested in providing a one-stage reconstruction of both the soft tissues and the missing bone segments. Since our standard flap for lower extremity reconstruction is a latissimus dorsi flap, we became interested in transferring a portion of the lateral border of the scapula along with the latissimus muscle. We dissected 34 cadaver scapulas in order to verify the reliability of the blood supply to the lateral border of the scapula based on the thoracodorsal artery. We then performed 12 "latissimus/bone flaps" from 1988 to 1992. Prior to flap transfer, control of the wound was obtained with surgical debridement and aggressive wound management. The flap usually was performed 5 to 7 days after initial contact with the patient. The muscle was skin grafted. All patients reported are ambulating, with x-ray evidence of bony incorporation of the transferred bone segment into the tibia. We feel that inclusion of the lateral scapula bone with the latissimus dorsi is a useful adjunct in the management of lower extremity trauma.