PMC5992936_01
(a) Long defect involving upper and middle 1/3rd of the leg. (b) Line diagram showing the anastomosis in a healthy zone posteriorly with the zone of trauma being in the anterior segment. Serratus anterior and latissimus dorsi are inset on either side of the anastomosis to provide complete wound cover. (c) end-to-end anastomosis of thoracodorsal donor vessels to the lateral genicular recipient vessel posteriorly with anterior zone of trauma. Serratus anterior and latissimus dorsi are inset on either side of anastomosis. (d) Latissimus dorsi and serratus anterior inset on either sides of the anastomosis
IJPS-51-24-g006.jpg
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F4
Debridement and external fixator application were done [Figure 4a]. Anastomosis was done to the lateral genicular artery, in a healthy plane posterior to the zone of trauma [Figure 4b and c]. The two muscles could be inset on either side of anastomosis, hence enabling complete wound cover [Figure 4d].
PMC5992936_02
(a) Defect involving part of mid-lower 1/3rd of leg and ankle. Wound cavity in the lower 1/3rd of the leg around the tibia. (b) Line diagram showing serratus anterior used to fill in the dead space surrounding the bone and latissimus dorsi used to surface the remainder of defect. (c) Photograph of dead space at lower leg filled by serratus anterior and remainder resurfaced with latissimus dorsi flap. (d) Six-week follow-up
IJPS-51-24-g007.jpg
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F5
The defect involved part of the middle 1/3rd and lower 1/3rd of leg as well as ankle, dorsum of foot and heel [Figure 5a]. SA was harvested. SA was placed around the muscle in the depth of the wound [Figures 5b, c and d].
PMC5992936_03
(a) Serratus anterior flap placed on the heel. (b) Line diagram showing use of serratus anterior to surface heel defect and latissimus dorsi for rest of the defect. (c) Heel defect covered by serratus anterior. Rest of the defect was covered by latissimus dorsi. Overlap of latissimus dorsi over serratus anterior was done during inset. (d) One-month post-operative picture
IJPS-51-24-g008.jpg
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F6
The left foot involved heel pad avulsion [Figure 6a]. Partial overlap of the two flaps at inset was present [Figure 6b, c and d].
PMC5992936_04
(a) Defect involving upper 1/3rd with degloved non-viable skin till the ankle. Degloved skin was debrided. The defect is broad proximally. (b) Line diagram showing use of serratus anterior to cover broader proximal part of defect. (c) Picture showing serratus anterior covering broad proximal part and remainder covered by latissimus dorsi flap. (d) Flap skin grafted
IJPS-51-24-g009.jpg
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F7
After debridement, he had a defect involving the upper 1/3rd to lower 1/3rd [Figure 7a]. SA was used to cover the broad proximal aspect and LD the remaining part of the wound [Figure 7b, c and d].