The Split Latissimus Free Flap for Reconstruction of Defects Around the Ankle: Exploring the Potential of the Workhorse.

The latissimus dorsi muscle flap is a widely used flap for soft tissue reconstruction. It is supplied by the thoracodorsal artery, which has a consistent intramuscular branching, allowing for flap division into 2 or more segments. We present a case of a 17-year-old woman with a complex lower extremity soft tissue defect involving the plantar foot and posterior ankle following a motorcycle accident. Reconstruction was performed using a latissimus dorsi musculocutaneous flap that was split between the transverse and descending branches of the thoracodorsal artery to create 2 independently perfused hemiflaps. The transverse portion resurfaced the Achilles tendon, whereas the descending portion covered the plantar wound. This case highlighted the utility of the split latissimus dorsi flap in reconstructing irregularly shaped, adjacent defects in the lower extremity with a single flap. Although fasciocutaneous flaps have gained popularity, the latissimus dorsi remains a reliable and adaptable workhorse flap due to its size, consistent anatomy, and minimal donor-site complications.