Application of the pedicled m. latissimus dorsi flap for trunk reconstructions (original) (raw)
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The Pedicled Descending Branch Muscle-Sparing Latissimus Dorsi Flap for Breast Reconstruction
Plastic and Reconstructive Surgery, 2009
The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely oriented skin paddle presents distinct advantages in breast reconstruction, including reduced donor-site morbidity and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, complications, and aesthetic and functional outcomes following use of this flap for breast reconstruction. Methods: A retrospective study of 20 patients who underwent breast reconstruction with a pedicled muscle-sparing latissimus dorsi musculocutaneous flap was conducted. Indications for surgery included breast reconstruction following mastectomy, lumpectomy, and irradiation, and for correction of implant-related complications. Case-note review was performed, as was a functional evaluation consisting of a patient questionnaire, a Disabilities of the Arm, Shoulder, and Hand form, postoperative range-of-motion analysis, and instrumented strength testing comparing the operated and nonoperated sides. Aesthetic evaluation of the donor site was conducted by all patients. An anatomical study of 15 flaps harvested from fresh cadavers was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch. Results: Twenty-four descending branch muscle-sparing latissimus dorsi flaps were harvested. All donor sites were closed primarily, with skin paddle sizes ranging up to 25 ϫ 12 cm. There was one case of minor flap tip necrosis and no instances of seroma. There was no statistically significant difference in strength or range of motion of the shoulder joint when comparing the operated to the nonoperated side. Two patients reported minor functional impact following surgery. Conclusions: The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar. (Plast. Reconstr. Surg. 123
Annals of Plastic Surgery, 2007
Complex injuries of the upper limb are usually associated with massive soft tissue necrosis, infection, and exposure of the vital structures. Management is fairly problematic, requiring multiple operations and prolonged hospitalization. We herein present a versatile use of the pedicled latissimus dorsi flap as a salvage procedure, and its advantages. In 6 patients with such injuries, all known variations of the flap have been successfully used as a musculocutaneous, pure muscle, and pure skin (thoracodorsal artery perforator) flap. The mean follow-up time was 11.8 months. All flaps survived completely. The donor sites were closed primarily, with acceptable linear scars in all cases. Variants of the pedicled latissimus dorsi flap may be suitable to address complex defects of the upper extremity, including forearm and hand, which have little chance for free flap. Content of the flap to be used should be determined depending on requirements in the recipient site.
An Audit of Pedicled Flap Reconstruction Surgeries
Journal of Medical Sciences, 2016
Objectives: To analyse the indications, post-operative results and frequency of complications for pedicled flaps reconstructiveprocedures.Material and Methods: This descriptive cross-sectional study was performed in the department of Plastic & BurnsSurgery, Khyber Teaching Hospital from January 2014 to April 2016. All the patients who has undergone reconstructivesurgeries irrespective of etiology were included in the study and their pre-operative evaluation, operative proceduredetails and post-operative course were observed.Results: A total of 123 cases with male to female ratio of 3.2:1, mean age of 42.8+1.76 SD were included with malignanciesas the most common cause and head and neck as the most common anatomical region for reconstructivesurgery. Flap necrosis was observed in 5.7% (n=7) cases, including 4 cases of insignificant and 3 cases of significantnecrosis. Wound infection noted in 6.5% (n=8) cases.Conclusion: For most of the anatomic regions of the body especially in head a...
Plastic and Aesthetic Research, 2017
Aim: Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available. Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included "trunk wound propeller flap", "trunk propeller flap", and "freestyle trunk wound flap". Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps. Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%). Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results. ABSTRACT
2014
Closing large skin defects of the upper back is a challenging problem. We have developed an efficient design for a latissimus dorsi musculocutaneous flap for reconstruction in this region. The longitudinal axis of the skin island was designed to be perpendicular to the line of least skin tension at the recipient site so that primary closure of the flap donor site changed the shape of the recipient site to one that was easier to close. We used this method for four patients with skin cancers or soft-tissue sarcomas of the upper back in 2011 and 2012. The size of skin defects after wide excision ranged from 11 3 10 to 25 3 20 cm 2 , and all skin defects could be covered by the flaps and all wounds of donor site could be closed without skin grafts. No wound complications occurred in any patient. Functional and aesthetic outcomes were satisfactory in all patients. This flap design is effective for reconstructing large skin defects of the upper back.
Versatility of Latissimus Dorsi Free Flap-a Prospective Study
Journal of Dhaka Medical College
Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the me...
Comparison of latissimus dorsi and rectus abdominis free flaps
British Journal of Plastic Surgery, 1987
This review of 41 latissimus dorsi and 7 rectus abdominis free flaps describes the advantages and disadvantages of these two donor tissues. Flap survival was over 95%. Rectus abdominis carries the greatest area of skin of all the free flaps and makes salvaging of extremities with massive soft tissue loss possible, and it also provides the most elegant small free muscle flap. The latissimus dorsi is suitable for nearly any defect of the body except the foot and the hand because of bulkiness of the tissue and poor development of sensation, and the face because of poor colour match.
The use of fillet flaps in upper extremity reconstruction
Journal of the American Society for Surgery of the Hand, 2002
ln unnsua!cases. extensiue sojt-tissue defects 0/the/(IJIJer extremity melY be reconstructed uith major fillet flaps. \Ve discuss the me 0/these flellJS CIS derived from the experience in usingthem on 8 selected patients d/(ring a 5-y«Ir period cit2 institmions. Etiology 0/ injlll)' for tcbicb these flaps are ideal indnde trauma and tumor resection or reconstruction. Defect locations iududed the sboulder. combined defects 0/ the shoulder plm neck. arm or chest wall. /(pper arm. and forearm. The majority 0/flaps require microsnrgica! [ree-tissue transfer. Unlike the classic spare-part, fillet-fiellJ concept, the partial or complete couiersiou 0/ an elf/atomicetlly intact arm Celli be IJer/ormed. especially ill tmuor recoustruaiou. Meljor filletfiellJS represent a minab!« option ill the armamentarinm for reconstruction in the /(IJller extremity u.it]: either pedided or free-tissue transfers iutolring extensive tissue defects.