Free latissimus dorsi musculocutaneous flap coverage of traumatic lower limb defect with transposition of the skin paddle: a flap within a flap.

The free latissimus dorsi (LD) musculocutaneous flap is a reliable option in the reconstruction of traumatic lower limb defects. It is particularly useful in the coverage of extensive or circumferential wounds because of its large surface area and thinness. Our paper presents a modification of this free flap by performing perforator-guided transposition of the distal portion of the skin paddle and utilizing it as an additional local flap to cover exposed bone. We believe that this method is simple, reproducible, and useful in extensive wounds where the critical defect cannot be covered by the LD muscle alone.