Two cases of endoscopic-assisted muscle harvest for lower extremity reconstruction are presented. Each case involved resurfacing the distal leg and dorsum of the foot with a split-thickness skin graft over a latissimus dorsi free flap. An endoscope with a video monitor and modified thoracoscopic instruments were used to assist in the muscle harvest. The principles of endoscopic muscle harvest include an incision long enough to remove the muscle, placed in the least conspicuous area that is within the reach of the instrumentation; retraction to optimize the optical cavity or visual working area; and use of video monitors to allow for coordinated assistance. The decrease in visible scarring is dramatic and represents the primary advantage over open techniques. We believe that the role of endoscopy will continue to expand as our experience increases and technology improves.
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