# A Game Changing, One of Its Kind Flap: The Boomerang-Shaped Extended Rectus Abdominis Myocutaneous Flap with Latissimus Dorsi Myocutaneous Flap

## TL;DR

This paper introduces a new surgical flap combining two muscle flaps to better reconstruct large limb defects.

## Contribution

The novel combination of BERAM and LD myocutaneous flaps offers a unique solution for extensive tissue coverage.

## Key findings

- Combining BERAM and LD flaps provides larger tissue coverage than separate free flaps.
- Vein grafts extend flap reach while avoiding anastomosis in injury-prone zones.
- The flap is particularly effective in children with reliable pedicle caliber.

## Abstract

Reconstruction of extensive limb defects is particularly difficult when standard flaps like the anterolateral thigh flap, latissimus dorsi (LD) flap, or the less popular large flap, boomerang-shaped extended rectus abdominis (BERAM) flap, are insufficient to cover the extensiveness of the raw area, even after extending with vein grafts. The BERAM and LD myocutaneous flap combines two flap areas into a single tissue unit, offering a novel solution to the issue. Interposition vein grafts help extending the reach further and avoids the anastomosis in a probable zone of injury area. In our experience, it gives the largest possible tissue for coverage compared to any two separate free flaps especially in children with a good caliber, reliable pedicle.