Flow-Through Thin Latissimus Dorsi Perforator Flap for Repair of Soft-Tissue Defects in the Legs

Abstract

Flow-through thin latissimus dorsi perforator flaps were used in six cases with complicated defects of the legs. This flap has a small amount of latissimus dorsi muscle with a considerable amount of fatty tissue removed to make a thin flap. In addition, the flap has several branches of the subscapular vessel, which are interposed to the recipient vessels of the legs. The advantages of this thin flap are: (1) flow-through vascular reconstruction can preserve the main vessels of the damaged legs; (2) the double arterial inflows and venous drainage systems of the flap ensure safe vascularization of the flap; (3) a flow-through venous drainage system from the distal extremities can also be established to prevent congestion of the affected legs; (4) this flap is versatile (it can be either thin or large); and (5) even in emergent ischemic legs, simultaneous elevation of the flap is possible with preparation of the legs. This flow-through flap is indicated for: (1) cases with a large skin defect and obstruction of the main vessels in the leg; (2) cases with a possibility of tumor recurrence in the legs; and (3) young women or girls with a large defect in the legs, rather than the rectus abdominis musculocutaneous flap.

Clinical analysis of 33 flow-through latissimus dorsi flaps

“…These two differences can be explained by a difference in the purposes of using flow-through flaps. Whereas in the previous reports, the flow-through flap was used to preserve or reconstruct the continuity of the recipient artery, 4,5,17,18 in our study this aim was of secondary importance. Our foremost aim was to improve the success rate of flap transfers.…”

“…The indications in previous reports have been limited to the reconstruction of distal extremities, such as the forearm, lower leg, hand, and foot. 4,5,17,18 By contrast, we used flow-through LD flaps in areas other than the distal extremities, including the proximal lower extremity (thigh and knee) in five cases, the Flow-through latissimus dorsi flap trunk in seven, and the scalp in seven, although it has been generally thought that the flow-through flap is not necessary for reconstruction in these areas. Second is the nature of the recipient artery.…”

“…In previous reports, authors reported using major arteries (including the ulnar, radial, and tibial arteries) as a recipient artery. 4,5,18 It is preferable to preserve or reconstruct the continuity of these major arteries to maintain adequate circulation in the distal extremity. In our study, more than half of the recipient arteries were not major arteries.…”

The early use of a perforator flap of the lateral lower limb in maxillofacial reconstructive surgery

“…The greatest experience is reported from WEI's group, who uses perforator-based flaps from the anterolateral thigh 6,10,16,20 . KOSHIMA et al reported on facial contour augmentation and closure of huge facial defects after resection of arteriovenous malformations using paraumbilical and anterolateral thigh (ALT) perforator flaps 14,15 .…”

“…Because of the well-known variability of cutaneous perforators in number and location, the transfer of perforator-based flaps is also described as 'free style microsurgery' 22 . Meanwhile, perforator-based flaps are raised from many different donor sites such as the thigh 6,7,16,20 , back 12 , abdomen 3,13 , the buttock 1 , forearm 4 , or the lower leg 14,11 . Preoperative mapping of the perforating vessels using Doppler sonography or colour Doppler duplex imaging can help to facilitate flap raising 9,17 .…”