Anterolateral thigh fl ap for contralateral adductor canal defects

to pressure areas from being in a right lateral position in her initial debridement.On day 4, the defect was reconstructed with a pedicled myocutaneous latissimus dorsi flap (a muscle-only latissimus dorsi flap with a skin graft was not chosen, as secondary contraction of the skin graft would have resulted in a flexion contracture of the neck). The insertion of latissimus dorsi was released to facilitate transposition of the flap to cover the defect, with the flap being tunnelled between the two heads of pectoralis major to gain access anteriorly. Peripheral areas not covered by the skin paddle were reconstructed using split thickness skin grafts. A pedicled pectoralis major flap was deemed not suitable, as the thoracoacromial vessels were thought likely to have been damaged by disease process. She did not require any further operative interventions. On discharge her functional deficit was confined to limited left shoulder abduction at 90° [Figure 3].Whilst we accept that skin grafts could have been used to cover the defect, this would have almost certainly committed her to numerous revision surgeries to correct the inevitable contractures. This case highlights the fact that severely immunocompromised patients can cope with pedicled flap reconstruction in the acute setting of necrotising fasciitis to facilitate coverage of exposed vital structures.