Objective:
Necrotizing fasciitis is a life-threatening condition primarily affecting the extremities, abdomen, and perineum, with a high mortality rate. We report the case of a 62-year-old male with necrotizing fasciitis in the left upper extremity, associated with liver abscess. Extensive debridement at another hospital resulted in the loss of the biceps brachii muscle, a large forearm defect, and loss of finger flexors. This case describes a unique approach to salvage the patient's upper limb function and overall recovery.

Methods:
The patient underwent a three-stage surgical intervention. Initially, a conjoined flap combining a pedicled latissimus dorsi muscle and a free groin flap was employed to reconstruct elbow flexion and cover the forearm defect. Subsequent procedures involved free functioning muscle transfer with the gracilis muscle flap and contracture release for finger joints. Sural nerve grafting was performed for sensory restoration in the fingers.

Results:
Cultures confirmed Klebsiella pneumoniae-related liver abscess and necrotizing fasciitis. The patient achieved significant motor function improvement. Ten months after the final procedure, he exhibited good range of motion in the left elbow and fingers, and regained muscle power.

Conclusions:
The conjoined latissimus dorsi-groin flap is a versatile surgical technique that proved effective in reconstructing extensive defects while restoring function of elbow flexion in a challenging case of upper extremity necrotizing fasciitis. Subsequent procedure of functioning muscle transfer restored flexion function of fingers.

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