{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:07:53Z","timestamp":1779959273910,"version":"3.53.1"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator\u2014a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical.<\/jats:p>","DOI":"10.3390\/clinpract16060102","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:00:36Z","timestamp":1779955236000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Random-Pattern Skin Paddle on a Free Latissimus Dorsi Flap as an Intraoperative Backup for Distal Lower-Limb Reconstruction: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-9208","authenticated-orcid":false,"given":"Ivan","family":"Budimir","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 2, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia"},{"name":"Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena ul. 21, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4827-1163","authenticated-orcid":false,"given":"Borna","family":"Vojvodi\u0107","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Clinic for Traumatology, Sestre Milosrdnice University Hospital Center,  Dra\u0161kovi\u0107eva 19, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rado","family":"\u017dic","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 2, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zlatko","family":"Vlaj\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 2, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domagoj","family":"Eljuga","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"},{"name":"Nursing Department, Bjelovar University of Applied Sciences, Trg Eugena Kvaternika 4, 43000 Bjelovar, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u017eo","family":"Gorjanc","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3962-4454","authenticated-orcid":false,"given":"\u017deljka","family":"Roje","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hrvoje","family":"Tucakovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u017deljka","family":"Gode\u010d","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7349-6487","authenticated-orcid":false,"given":"Marko","family":"Bari\u0107","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2281-1069","authenticated-orcid":false,"given":"Josip","family":"Jaman","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7921-1905","authenticated-orcid":false,"given":"Rhea Marie","family":"Mu\u017ear","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6025-4806","authenticated-orcid":false,"given":"Kre\u0161imir","family":"Marti\u0107","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Avenija Gojka \u0160u\u0161ka 6, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 2, 10000 Zagreb, Croatia"},{"name":"Nursing and Physiotherapy Department, University North, Jurja Kri\u017eani\u0107a 31b, 42000 Vara\u017edin, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","unstructured":"Wei, F.C., and Mardini, S. (2016). Flaps and Reconstructive Surgery E-Book, Elsevier Health Sciences."},{"key":"ref_2","unstructured":"Kalaskar, D.K., Butler, P.E.M., and Ghali, S. (2016). Textbook of Plastic and Reconstructive Surgery, UCL Press."},{"key":"ref_3","unstructured":"Blondeel, P., Morris, S., Hallock, G.G., and Neligan, P. (2024). Perforator Flaps: Anatomy, Technique, & Clinical Applications, Georg Thieme Verlag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1016\/j.bjps.2009.12.020","article-title":"Thoracodorsal artery perforator flap and latissimus dorsi myocutaneous flap\u2014Anatomical study of the constant skin paddle perforator locations","volume":"63","author":"Schaverien","year":"2010","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.bjps.2009.05.042","article-title":"Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution","volume":"63","author":"Watanabe","year":"2010","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"776e","DOI":"10.1097\/PRS.0b013e31826d9c5e","article-title":"The free descending branch muscle-sparing latissimus dorsi flap: Vascular anatomy and clinical applications","volume":"130","author":"Colohan","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1177\/0194599819844997","article-title":"Complications and Outcomes of Chimeric Free Flaps: A Systematic Review","volume":"161","author":"Ettyreddy","year":"2019","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Filigheddu, E., Ziani, F., Arrica, G., De Riso, S., Manconi, A., Rubino, C., and Trignano, E. (2025). Microsurgical Reconstruction of Extensive Lower Limb Defects: Latissimus Dorsi Free Flap for Circumferential Soft Tissue Loss Following High-Energy Trauma. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134424"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rampi, A., Comini, L.V., Galli, A., Howardson, B.O., Tettamanti, A., Luparello, P., Redaelli, G., Di Santo, D., and Bondi, S. (2024). Reconstructive Surgery of the Head and Neck in Organ Transplant Recipients: A Case Report and a Review of the Literature. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164790"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1080\/08941939.2020.1795952","article-title":"Latissimus Dorsi Myocutaneous Flap Procedure in a Swine Model","volume":"34","author":"Etra","year":"2021","journal-title":"J. Investig. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/s00064-011-0094-y","article-title":"Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity","volume":"24","author":"Knobloch","year":"2012","journal-title":"Oper Orthop Traumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1097\/PRS.0000000000005448","article-title":"Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature","volume":"143","author":"Crowe","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/PRS.0000000000006063","article-title":"Reconstruction of Gustilo Type IIIC Injuries of the Lower Extremity","volume":"144","author":"Ricci","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.injury.2019.10.045","article-title":"Selecting a free flap for soft tissue coverage in lower extremity reconstruction","volume":"50","author":"Kozusko","year":"2019","journal-title":"Injury"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0037-1607323","article-title":"Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps","volume":"34","author":"Philandrianos","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1055\/s-0036-1586748","article-title":"Risk Factor Analysis of Freestyle Propeller Flaps","volume":"33","author":"Paik","year":"2017","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_17","first-page":"87","article-title":"Propeller Flaps and Its Outcomes\u2014A Prospective Study of 15 Cases Over Two-years","volume":"8","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/micr.30827","article-title":"The triple conjoined scapular-latissimus dorsi-groin flap for reconstruction of long lower extremity degloving injury: A case report","volume":"42","author":"Amendola","year":"2022","journal-title":"Microsurgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/PRS.0000000000000365","article-title":"A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer","volume":"134","author":"Lee","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/SAP.0000000000001425","article-title":"Skin Paddles Improve Muscle Flap Salvage Rates After Microvascular Compromise in Lower Extremity Reconstruction","volume":"81","author":"Stranix","year":"2018","journal-title":"Ann. Plast. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"575","DOI":"10.5999\/aps.2013.40.5.575","article-title":"Reconstruction of the lower extremity using free flaps","volume":"40","author":"Kang","year":"2013","journal-title":"Arch. Plast. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"He, J., Guliyeva, G., Wu, P., Qing, L., Yu, F., and Tang, J. (2022). Reconstruction of Large Soft Tissue Defects in the Distal Lower Extremity: Free Chain-Linked Bilateral Anterolateral Thigh Perforator Flaps versus Extended Latissimus Dorsi Musculocutaneous Flaps. J. Pers. Med., 12.","DOI":"10.3390\/jpm12091400"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1111\/os.13454","article-title":"Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity","volume":"14","author":"He","year":"2022","journal-title":"Orthop. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.2106\/JBJS.20.00022","article-title":"Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction: Five-Year Consecutive Single-Surgeon Series","volume":"102","author":"Chim","year":"2020","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"412e","DOI":"10.1097\/PRS.0000000000006522","article-title":"The Muscle-Sparing Descending Branch Latissimus Dorsi Free Flap for Lower Extremity Reconstruction","volume":"145","author":"Kurlander","year":"2020","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.injury.2010.10.006","article-title":"Costs and coding\u2014Free-flap reconstruction in lower-limb trauma","volume":"42","author":"Townley","year":"2011","journal-title":"Injury"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.bjps.2015.12.011","article-title":"Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes","volume":"69","author":"Repo","year":"2016","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.bjps.2017.04.001","article-title":"Systematic review: Early versus late dangling after free flap reconstruction of the lower limb","volume":"70","author":"McGhee","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_29","first-page":"347","article-title":"Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity","volume":"38","author":"Qi","year":"2022","journal-title":"Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/6\/102\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:51:50Z","timestamp":1779958310000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/6\/102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["clinpract16060102"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16060102","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}