Pedicle or Free Musculocutaneous Flaps for Shoulder Defects After Oncological Resection

Abstract

Management of soft-tissue defects of the shoulder is described. Extensive defects of soft tissues with or without overlying skin were created after resection of sarcomas in five patients. Reconstruction was performed using musculocutaneous flaps, which included three pedicle latissimus dorsi and two free tensor fascia lata flaps. Simultaneous functioning replacement of the defects of the trapezius and deltoid muscles were each achieved in two patients. Primary wound healing was achieved, and each patient recovered good contour of the shoulder. Functional results were satisfactory in all patients with an average score of 93.4% (range, 83%-100%) using the system of the Musculoskeletal Tumor Society. The four functioning muscles recovered active contraction in the transferred position. The shoulder elevation was normal in three patients, and was 90 degrees and 30 degrees in one patient each. All patients remained disease-free at the time of latest follow-up. Thus, shoulder defects of the soft tissues can be managed appropriately with the two representative musculocutaneous flaps.

Functional Free Muscle Transfer for Upper Extremity Reconstruction

“…Grip strength was approximately 25 percent that of the contralateral side. 14,15,[33][34][35][36] Other indications including reconstruction after trauma and congenital deficits have also been reported with similar functional outcomes, typically recovering Medical Research Council grade 4 motor recovery. 6 In 2011, they reported on a modification of their technique to provide independent thumb flexion by separating the fascicles of the obturator nerve and using two donor nerves, providing separate innervation to the neurovascular territories of the gracilis muscle.…”

Pedicled Latissimus Dorsi Flap for Shoulder Soft-Tissue Reconstruction After Excision of a Musculoskeletal Neoplasm

“…Occasionally, the pedicled latissimus dorsi flap is not available, as in cases where the pedicle was frankly divided, excised with the tumor, or otherwise compromised during current or prior surgical dissection or in cases of previous rotation. In these circumstances, the use of a free flap may be the only available option for soft-tissue reconstruction [10,11]. In most circumstances, however, the pedicled latissimus dorsi flap is our choice for reconstructing defects around the shoulder after tumor excision.…”

Latissimus dorsi flap closure of the irradiated clavicular wound

“…3,7,11,[17][18][19][20]24,30,32 In most cases, the pedicled latissimus dorsi flap has been used, 7,11,20,24,30,32 but pedicled pectoralis major, trapezius, rectus abdominis, and deltoid muscle flaps, as well as tensor fascia lata free flaps, have been used after trauma, oncologic resection, and radiation therapy. 3,11,17,20,25,32 As do we, Ihara et al 20 believe that the pedicled latissimus dorsi flap is the best option for reconstruction of the wide defects created after resection of a shoulder sarcoma. Chest wall reconstruction after multiple rib and sternum resection has also frequently been reported.…”