الفهرس 
Relevant surgical anatomy of the legOnly 14 pages are availabe for public view
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Abstract
The advent of free tissue transfer has provided multiple options for
difficult soft tissue defects of the lower extremity that allow the
preservation and maintain the functional and aesthetic status of the limb.
Since the first report of the latissimus dorsi flap by Tansini i1896, it has
become one of the most commonly used flaps in reconstruction of various
soft tissue defects. The flap has gained popularity because it has a large
muscle surface area, can be elevated with a considerable skin paddle, and
has a long and wide vascular pedicle with consistent anatomy and
acceptable donor site morbidity and the thickness of the flap can be
adjusted.
In this thesis, a study was done to evaluate the indications, advantages,
disadvantages, and complications of reconstruction of complex soft tissue
defects in the lower extremities using free latissimus dorsi muscle flap.
The study was carried out on 16 patients with complex soft tissue
defects of the lower extremities (12 males and 4 females), their age ranged
from 7 to 55 years. The causes of the soft tissue defects were trauma,
unstable graft, osteomyelitis and soft tissue sarcoma.
The site of the defect was at the middle and lower thirds of the leg in 5
patients, at lower third leg and ankle in 8 patients, at dorsum of foot in 2
patients and at sole of foot in 1 patient.
The average number of debridement sessions before definitive coverage
was 1.4 times per patient. The average time of definitive coverage in
trauma patients was 7 days post trauma and more than 6 months in other
causes. The mean duration of the operation was 6.2±1.3 hours. The
microvascular anastomosis was done to the anterior tibial vessels in 5
patients and to the posterior tibial vessels in 11 patients.
A total of 15 flaps (93.75%) survived completely, and one flap (6.25%)
totally lost due to venous thrombosis. Recipient site complications include
hematoma under the flap in one patient (6.25%), wound infection in 4
patients (25%), osteomyelitis in 1 patient (6.25%), and patchy skin graft
losses in 7 patients (43.75%).
Donor site complications included seroma in 4 patients (25%),
hematoma in 1 patient (6.25%), major wound dehiscence in1 patient
(6.25%), minor wound dehiscence in2 patients (12.5%) and wound
infection in 1 patient (6.25%).
The patients during their average one year follow up showed no
significant limitation of shoulder mobility, with nearly equal mobility of
both shoulders. The reconstructed recipient sites were pain free with
adequately accepted appearance on the average.