In recent years, numerous studies have reported the good therapeutic effect of early vascularized free tissue transplantation for a severe open fracture of the lower extremity with soft tissue damage. Reconstruction using a free latissimus dorsi flap was performed for severe open fracture of a lower extremity injured in a marine environment. Although a good result was obtained eventually, we found that a relatively long period was required until bone union and full load bearing.
A 65-year-old man was injured when he entangled his lower leg in the net of a fishing boat. On the day of injury, debridement, external fixation, and wound closure were performed. Seven days after the injury, infection caused by marine environment-specific bacteria was observed; therefore, debridement, and negative pressure wound therapy were performed. One month after the injury, reconstruction using a free latissimus dorsi flap was performed. At 4.5 months after the injury, non-vascularized free iliac cancellous bone grafting and internal fixation were performed. Thirteen months after the injury, the bone union was confirmed. Sixteen months after the injury, the patient could walk without a crutch, and he returned to work on a fishing boat.
