Free tissue transfer can be a challenging aspect of lower extremity reconstruction. Most of the literature reflects care for adult patients. We describe a case report of a unique experience of a chimeric musculocutaneous latissimus dorsi and serratus anterior free flap for extensive soft tissue coverage in a very young pediatric patient following a Gustilo IIIC injury.

An otherwise healthy twenty-two month old patient sustained a large open crush and degloving lower extremity fracture injury with lengthy pulselessness and underwent vascular and orthopaedic reconstruction. Reconstructive staged procedures included tissue debridement, placement of external fixator, delayed free tissue transfer, Integra application, and skin grafting.

Goals of achieving complete healed soft tissue coverage and limb salvage were achieved.

Complex mangled lower extremity injuries in very young pediatric patients may be safely managed with staged procedures including free tissue transfer. We discuss an algorithm for management of lower extremity reconstruction.