Free Composite Latissimus Dorsi Muscle-Rib Flap Not Containing the Intercostal Artery and Vein for Reconstruction of Bone and Soft-Tissue Defects

Repair of bone and soft-tissue defects of the head and leg which had been difficult to undertake in the past has been facilitated in recent years with the technical advancement being made in microsurgery and the development of new flaps. Reconstruction using the free composite latissimus dorsi muscle-rib flap not containing the intercostal artery and vein was done by us on two traffic accident cases, the first case having a severe deformity extending from the forehead to the nasal tip with a frontal bone defect and the second case with bone and soft-tissue defects of the leg accompanied by osteomyelitis. The free composite latissimus dorsi muscle-rib flap not containing the intercostal artery and vein that was used in this procedure is based on the vascular system extending from the nutrient arteries and veins to the periosteal vascular network by means of the rib attachment site of the latissimus dorsi muscle. This flap, which was developed in 1990 by Kobayashi et al.,1 has been used in reconstruction of the mandible. In using this flap as a free composite latissimus dorsi muscle-rib flap, we have confirmed it to be extremely useful.