• The ten-year experience with difficult wounds of the lower extremity at the Atlanta Veterans Administration Medical Center is reviewed in order to evaluate the use of the muscle and musculocutaneous flap as regional and free-tissue transfers. Twenty-four patients had chronic wounds and five had acute bony and soft-tissue injury. A total of 34 procedures, including 18 regional flaps and 16 microvascular free-tissue transfers, were performed with an overall success rate of 74%. Regional transfer succeeded in 12(67%) of 18 cases. Free-tissue transfer succeeded in 13 (81%) of 16 cases. Experience with regional muscle transfer has shown the gastrocnemius and soleus muscles to be excellent choices for reconstruction of the proximal and middle third of the lower leg. Free microvascular transfer of the latissimus dorsi, gracilis, and rectus muscles has provided reliable closure in wounds that are chronically infected with major bony and soft-tissue loss in the distal third of the lower extremity.
(Arch Surg 1984;119:921-925)