Free hemiback flap with surgical delay for reconstruction of extensive soft tissue defect: A case report

Abstract

A delay procedure allows for reliable tissue transfer in random pattern flaps and axial pattern flaps. However, delay procedures have not been studied in free flaps. In this report, we present a case involving the use of a free extended latissimus dorsi musculocutaneous flap (hemiback flap) that included half of the total back skin and was based on thoracodorsal vessels for reconstruction of an extensive soft tissue defect of the flank and waist. The flap was tailored in combination with a delay procedure. Intraoperative indocyanine green fluorescence angiography indicated profuse perfusion except for the most inferomedial part of the flap, which was discarded. The flap survived. A free hemiback flap may offer a valuable option for reconstruction of extensive soft tissue defects. To our knowledge, this is the first report to demonstrate a free flap made in combination with a delay procedure.

Combination of a fillet flap, free tissue transfer, and autologous tissue grafts in pelvic reconstruction following retroperitoneal sarcoma: A case report

“…The fillet flaps used in posthemipelvectomy reconstruction have successful reconstructive outcomes with minimal morbidity and flap failure . Alternatively, case studies without the availability of spare parts have reported the successful use of pedicled vertical rectus abdominis musculocutaneous (VRAM) flow‐through flaps and free hemiback flaps in the reconstruction of extensive soft tissue defects …”

“…5 Alternatively, case studies without the availability of spare parts have reported the successful use of pedicled vertical rectus abdominis musculocutaneous (VRAM) flow-through flaps and free hemiback flaps in the reconstruction of extensive soft tissue defects. 12,13 The principle of the usage of "spare parts" following amputation is to minimize the use of alternative donor sites and accompanying morbidity and providing the patient with permanent coverage of the reconstruction site. 3 The viability and potential for the amputated part presents an interesting role when considering any surgical reconstructive case.…”

Suprafascial pre‐expansion of perforator flaps and the effect of pre‐expansion on perforator artery diameter

“…Actually, in pre‐expanded perforator flaps the pedicle is located more peripherally, usually in one pole of an elliptical flap and thus the pedicle is more distant to the distal portion of the flap when compared to a pedicle that is centrally located. Delay procedures have already been known to improve flap survival and allow for reliable transfer of greater volumes of tissue in axial pattern flaps . Albeit an expanded flap may be considered as an alternative delay procedure, other types of delay procedures could also have been added to some of the extended flaps of our series in order to reduce the possibility of partial flap loss.…”

“…Albeit an expanded flap may be considered as an alternative delay procedure, other types of delay procedures could also have been added to some of the extended flaps of our series in order to reduce the possibility of partial flap loss. For instance, “delay of incisions on three sides” as used by Fujiwara et al and Tosun et al seems to be the effective method for our pre‐expanded donor sites. As aesthetic resurfacing had been an important element of the purpose of the treatment for these three patients, we decided to further manage the grafted areas and residual scars by subsequent tissue expansion of the transferred flaps and the neighboring healthy tissues.…”

“…To ensure consistency among measurements, same radiologist performed all of the CDU examinations. The ultrasound examinations were performed with My-Lab 70 (Esaote, Genova, Italia), using a highfrequency linear array probe (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Complications that were evaluated included perfusion-related complications and expander related complications.…”