This case illustrates that a massive muscle flap such as the combined latissimus dorsi and serratus anterior can survive using the cross-leg free flap technique, and this would be a valuable option for large lower extremity defects that have no reliable recipient artery.
Cross-leg free muscle flaps of large volume such as the latissimus dorsi have been described before [3, 4, 5].
Tissue flaps such as fascia flap, muscle flap, and peritoneum flap have rich blood supply and can be used as the vascular bed to enhance the vascularization of tissue engineered bone [ 22– 22].
16 Some free flaps are very challenging to monitor adequately, such as vascularised bone and muscle flaps; especially those that have been covered with a skin graft and cutaneous flaps in non-Caucasian skin.
Tissue engineered bone grafts can be wrapped in the soft tissue flaps such as pedicle fascia flap, muscle flap, or periosteum flap to complete the vascularization in vivo by microsurgical technique and the surface of bone graft can be invaded with new vascular networks.
To avoid the reoperation and shorten the treatment time, the vascular pedicled flaps such as pedicled fascia flap, pedicled muscle flap, and pedicled periosteum flap are used to achieve the vascularization of tissue engineered bone graft in vivo.
Over the past few decades, many lower limb wound coverage techniques have been described, such as free flaps [1], random local flaps [2], distally based muscle flaps [3, 4], staged and undelayed fascial [5, 6] and fasciocutaneous flaps [7, 8, 9, 10, 11] and reverse flow arterial flaps [12, 13].
Numerous alternative treatments such as handmade expanders and implants, latissimus dorsi flaps, and rectus abdominals muscle flaps have been proposed to correct the most important deformities caused by this syndrome, but all have offered only a partial correction of the deformities, with poor aesthetic results [ 1, 6– 8].
There are accordant risks for flap avulsion or compromise of the vascular pedicle, especially in the newer perforator based flaps, such as the DIEP flap, which were developed to spare the abdominal donor site morbidity associated with increased muscle harvest of the rectus abdominis muscle, but leave the vascular pedicle much less protected.
