During the past 4 years, our trauma and reconstructive service has tre
ated a number of patients with lower extremity trauma involving the lo
ss of both soft tissue and significant segments of tibia. While there
are many methods for reconstruction of such defects, we became interes
ted in providing a one-stage reconstruction of both the soft tissues a
nd the missing bone segments. Since our standard flap for lower extrem
ity reconstruction is a latissimus dorsi flap, we became interested in
transferring a portion of the lateral border of the scapula along wit
h the latissimus muscle. We dissected 34 cadaver scapulas in order to
verify the reliability of the blood supply to the lateral border of th
e scapula based on the thoracodorsal artery. We then performed 12 ''la
tissimus/bone flaps'' from 1988 to 1992. Prior to flap transfer, contr
ol of the wound was obtained with surgical debridement and aggressive
wound management. The nap usually was per formed 5 to 7 days after ini
tial contact with the patient. The muscle was skin grafted. All patien
ts reported are ambulating, with x-ray evidence of bony incorporation
of the transferred bone segment into the tibia. We feel that inclusion
of the lateral scapula bone with the latissimus dorsi is a useful adj
unct in the management of lower extremity trauma.