Latissimus dorsi pedicle flap for coverage of soft tissue defects about the elbow (original) (raw)
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The Internet journal of plastic surgery, 2011
Major complicated injuries of the upper limb that once led to amputation are now being successfully salvaged. The goals of treatment in such cases are rigid fixation of fractures, reliable stable coverage of important structures, preservation of function and an acceptable cosmetic result. There is no consensus in the literature regarding the treatment strategy of upper limb trauma with damage distal to the olecranon. The latissimus dorsi musulocutaneous flap is often used for upper limb reconstruction for functional elbow restoration following different sorts of injures [1-5].We report two cases of major trauma of the elbow and forearm distal to the olecranon, that have been successfully treated by skeletonized, pedicled, denervated latissimus dorsi musculo-cutaneous flaps.
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.
Use of a Pedicled Flap for Reconstruction of Extensive Soft Tissue Defects Around Elbow
J Coll Physicians Surg Pak, 2010
The case series describes 28 patients admitted in Shaikh Zayed Hospital, Lahore, from February 2003 to January 2008 with extensive soft tissue defects around the elbow. Elderly patients with previous history of myocardial infarct, heart failure, chronic obstructive pulmonary disease or insulin dependent diabetes were ABSTRACT Objective: To determine the reliability of pedicled latissimus dorsi flap for reconstruction of extensive defects around the elbow in terms of flap survival and coverage of exposed bones, vessels or nerves. Study Design: Case series.
Erciyes Medical Journal, 2023
The purpose of this investigation was to evaluate the effectiveness of a pedicled latissimus dorsi musculocutaneous flap (PLDMF) applied to trauma-complicated large soft tissue defects in the upper extremity up to the elbow area. Materials and Methods: Six patients who received a PLDMF at our clinic for a traumatic soft tissue defect around the elbow between 2014 and 2019 were included in this prospective follow-up, retrospective cohort-type analysis. In addition to the extent of the soft tissue defect, the length of postoperative hospitalization, follow-up, complications, and time to return to work, the patient's demographic information was also noted. The Q-DASH questionnaire was used to assess elbow and shoulder joint range of motion (ROM) 9 months after surgery. Results: Six male patients with an average age of 39.8±13.07 years had defects with a mean size of 272 cm 2. In a patient who underwent amputation at the elbow level, a flap was used to treat an antecubital deformity after replantation in the same session. Three patients experienced hematoma in the donor location, superficial necrosis distal to the flap, and superficial infection. They were released after 14-29 days. The flaps survived in all patients, and both the Q-DASH questionnaire and shoulder and elbow joint ROM outcomes were satisfactory. Conclusion: In complex soft tissue problems around the elbow joint that may need extensive therapy and would probably result in disability, a PLDMF can be used safely. Intraoperative Doppler ultrasonography helps prevent the most typical consequence, distal necrosis.
“Close-open-close free-flap technique” for the cover of severely injured limbs
Injury, 2019
The treatment of severely injured extremities still presents a very difficult task for trauma orthopaedic surgeons. Despite improvements in technology and surgical/microsurgical techniques, sometimes a limb must be amputated, otherwise severe and potentially fatal complications may develop. There is a wellestablished belief that severe open fractures should be left open. However, Godina proved wound coverage in the first 72 h (after an injury) to be safe and to bring good final results. So early wound cover (no later than one week after an injury) with well vascularized free flaps became the gold standard. Yet for many patients (some of whom have serious health problems), operative treatment needs to be postponed when they arrive to specialized microsurgical departments for microsurgical reconstruction much later than one week after incurring an injury. As the definite wound cover period from one week to 3 months seems to be hazardous, especially due to the potential of infection, we developed a safe, original flap technique that prevents infection and covers important structures such as exposed bones, tendons, nerves and vessels. We named this technique the "close-open-close free flap technique". It enables difficult wound cover in any biological phase of the wound, by combining complete flap cover first, with the removal of stitches from one side of the flap after 6-12 h. This technique works very well for borderline cases as well; where even after a complete debridement, dead tissue still remains in the wound-making wound cover very dangerous. Closing completely severe open fractures with free (or pedicled) flaps and removing the stitches on one side after 6-12 h, enables orthopaedic surgeons to safely cover any kind of wound in any biological phase of the wound. Additional debridements, lavages and reconstructions can easily be performed under the flap and after the danger of a serious infection has disappeared, definitive wound closure can be carried out.
The Antero-Lateral Thigh Flap in Coverage of Extensive Post Traumatic Upper Limb Defects
Surgical Science, 2016
Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a "two team" approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.
2016
Background/Purpose: Latissimus dorsi muscle (LDM) is one of the most versatile muscles that is commonly used in different reconstructive procedures. Severe mutilating injuries of the upper limb in children represent a great challenge to reconstructive surgeons especially when important structures become exposed. Materials & Methods: we utilized LDM as an island flap to cover extensive soft tissue defects in the upper limb of pediatric patients. This work included 17 children (13 males and 4 females). All of them had extensive soft tissue loss of the upper limb with exposure of important structures. The cause of injury was road traffic accident in all patients. We analyzed the operative time, need for multi-stage surgery and the recorded complications. Finally, we recorded the ultimate functional and aesthetic outcome after a period of two years of follow up. Results: From the harvested seventeen flaps, none of them was lost. Split thickness skin graft was done one week after flap ha...
Repair of bilateral lower limb injuries using a free latissimus dorsi cross-leg flap
European Journal of Plastic Surgery, 1999
Current microsurgical techniques are used in single stage repair of distal lower limb defects. The previously popular cutaneous and fasciocutaneous flaps have been practically shelved. However, in selected cases, the vessels of a lower limb can still be employed to vascularize a harvested flap for the repair of a contralateral defect. In cases where the vessels of a traumatized leg are severely damaged or jeopardized, vascular components of the opposite limb can be exploited to provide the blood supply for the flap chosen to cover the defect. There are times when trauma to both legs may require a single large flap (latissimus dorsi) which if properly vascularized can bridge a bilateral defect. This could bring about the revival of the cross-leg flaps. Four cases are reported: in one, the flap was vascularized from a healthy limb to cover a contralateral exposed fracture and an avulsed heel. In three other cases, the latissimus dorsi was utilized to fill large post-traumatic bilateral defects at the distal lower limb level. In these cases the limb with the best vascular system was chosen for flap anastomoses and fixation was then applied.