Aims: In some severe lower limb injuries, the level of bone trauma enables preservation of knee joint only if the soft tissues can be reconstructed over the exposed bone. The options for soft-tissue reconstruction of an amputation stump are to use a ßap from the amputated distal part, a local ßap possibly after tissue expansion or a free ßap. Methods: To preserve an adequate length of stump we reconstructed 10 stumps with latissimus dorsi free ßaps: above the knee in one and below the knee in nine. The reconstructions were done during the acute post-traumaic phase in þve and for late problems with the stump in four patients. In one patient the reconstruction was done nine weeks after a below-knee amputation for ischaemic necrosis after septicaemia. Results: All ßaps survived, but the venous anastomosis had to be revised in three patients in the early post-operative period. All patients regained adequate ambulation for their daily activities. The ßap was secondarily debulked in three patients. Conclusions: Every effort should be made to preserve an adequate stump length, particularly in young patients with crushing injuries of the extremities and when there is severe or recurrent late stump ulceration. A latissimus dorsi musculocunaeous soft-tissue reconstruction is reliable and durable option for stump defects.

Bone defects can be reconstructed by shortening, conventional cancellous bone grafting, bone transport or microvascular bone grafts. Each method has special indications, advantages and disadvantages.

Microvascular bone grafts provide living, solid bone to fill or bridge bone defects. They also promote bone healing and resist infection. However, microvascular bone grafting entail increased duration of the operation, a two team approach and it bears the risks of donor site morbidity. Therefore only extensive defects or poor prospect of healing warrant this method.

Iliac crest flap is mainly used to reconstruct metaphyseal or articular defects. It offers a large piece of corticocancellous bone, with an option to make an arthrodesis, if indicated.

Microvascular fibula is used to bridge long diaphyseal defects (traumatic, congenital) or to reconstruct avascular bone necrosis.

Osteomuscular latissimus dorsi flap (including the lateral part of scapula) offers a solution for bone and soft tissue defects, especially in open comminuted fractures, infected nonunion fractures or post-operative deep bone infections.

Aims: Acquired defects of the back primarily are the result of radiation injury, trauma, tumour ablation, or wound dehiscence and infection. The incidence of these defects is growing, since the demand of spinal operations for degenerative spinal diseases and tumour resections is increasing. The reconstructive techniques for posterior trunk defects have improved, because of the use of muscle ßaps. When there are extensive wounds, free ßap reconstruction may be the only option to assure durable coverage. We wanted to evaluate the outcome of these patients. Methods: We review our series of these reconstructions. Results: 16 patients with difþcult wounds of the posterior trunk were treated with various ßaps. The causes of posterior trunk defects were a post operative wound dehiscence or infection (13), tumour (2), meningomyelocele (1). Mean follow-up period was 63 months. The wound location was cervical area (4), upper and midthoracic area (3), lower thoracic and thoracolumbar area (5), lumbosacral area (2), and sacral area (2). The defects were closed by fasciocutaneous ßaps (3), musculocutaneous trapezius ßaps (4), trapezius muscle ßap (1), latissimus dorsi muscle ßap (1), paraspinous muscle ßaps (3), and gluteus muscle ßap (1). In addition, three patients underwent microvascular transfer of the latissimus dorsi muscle. The exposed orthopedic hardware could be left in place in þve out of seven cases. The muscle ßaps did not cause any major functional deþcit in the donor sites. Conclusions: A high rate of success is obtained in the management of posterior trunk defects with muscle ßaps. Adequate debridement of all devitalised tissues and coverage with well vascularized tissue to obliterate any residual dead space and to cover orthopedic hardware are mandatory and prerequisite.