Endoscopy-assisted harvesting and free latissimus dorsi muscle flap transfer in reconstructive microsurgery

Because of their generous dimensions, constant anatomy, great plasticity and well defined vascularization, muscles remain the preferred choice when approaching reconstruction of complex tissue defects resulting after trauma or oncological resections. The latissimus dorsi, represents a widely used flap when performing reconstructive microsurgery using free tissue transfer, but with important postoperative complications like seroma, donor-site hematoma and large scars. Along with the development of video assisted harvesting of muscular free flaps, the minimal invasive approach brings an important decrease of the donor site morbidity, followed by a faster healing. This article presents the case of a patient diagnosed with chronic osteomyelitis fistula, on the site of an older posttraumatic fracture at the level of the tibial diaphysis, where a large debridement of soft tissues and the involved bone was performed, followed by microsurgical reconstruction of the left over defect, using a free latissimus dorsi muscular flap harvested by endoscopic-assisted technique.