The free latissimus dorsi flap as primary free flap and crane flap with secondary pedicled transfer.

We are reporting a case of a 43-year-old woman, who developed a soft tissue defect of the knee region following complex lower limb trauma. The defect was covered with a microvascular latissimus dorsi (LD) flap. The patient required a total knee replacement and developed a defect at the anterior aspect of the knee. This defect was covered by a second free LD flap from the ipsilateral side with anastomosis to the superficial femoral artery. Thrombosis of the superficial femoral artery resulted in complete flap loss. The soft tissue defect was covered with a pedicled medial gastrocnemius flap. Further surgery was undertaken to reconstruct the extensor mechanism of the knee. The resulting soft tissue defect was covered with a free anterolateral thigh (ALT) flap, which failed. The resulting defect left the knee prosthesis exposed. We used the first free LD flap covering the medial aspect of the lower leg as a pedicled axial myocutaneous flap. The deep portion of the flap remained in situ, covering the original soft tissue defect of the lower leg, and the main bulk of the LD was rotated by 180 degrees to the anterior defect of the knee. The crane flap healed uneventfully with a good outcome.