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

Engdahl, Ryan; Disa, Joseph J.; Athanasian, Edward A.; Healey, John H.; Cordeiro, Peter G.; Fabbri, Nicola

doi:10.2106/jbjs.st.16.00002

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…LD flaps with STSGs are a standard and appropriate soft tissue coverage tool. In this case, the STSG protected the muscular flap and underlying prosthesis 14,15 . The patient's transected radial nerve was repaired during the definitive procedure to augment her long-term function 16 .…”

Section: Discussionmentioning

confidence: 90%

Tiger Attack Resulting in a Humeral Defect Treated with Proximal Humeral Replacement and Latissimus Dorsi Flap

Murphy,

Judson,

Edge

et al. 2023

JBJS Case Connector

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Case:A 69-year-old woman presented with a type IIIB left proximal humerus fracture with a 500-square-centimeter soft tissue defect, 10-cm bone defect, and radial nerve laceration after a tiger attack. The surgical intervention included proximal humeral replacement with muscular integration, radial nerve repair, and latissimus dorsi flap coverage.Conclusion:This case presents an exceedingly rare injury mechanism resulting in a significant soft tissue and bone defect. Its novelty lies in the complexity of the injury, which required a well-coordinated multispecialty treatment approach. This strategy applies to injuries with similar extensive soft tissue and bone defects.

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Section: Discussionmentioning

confidence: 90%

Tiger Attack Resulting in a Humeral Defect Treated with Proximal Humeral Replacement and Latissimus Dorsi Flap

Murphy,

Judson,

Edge

et al. 2023

JBJS Case Connector

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“…In our entire cases, the flap was rotated in anticlockwise direction with a subcutaneous tunnel in the anterolateral aspect of the chest wall. However, when the defect is more posterior and superior to the shoulder, the posterior clockwise rotation of the flap can be done [11]. Large surface area of the flaps in our series led to the requirement of donor site skin grafting.…”

Section: Discussionmentioning

confidence: 91%

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Naalla¹,

Raju²,

Sharma³

et al. 2019

IMJ

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IntroductionWide excision of the soft tissue tumors around the clavicle results in extensive defects frequently leading to exposure of critical neurovascular and skeletal structures. Early healing and stable vascularized soft tissue coverage are necessary for adjuvant chemo-radiotherapy in many instances. When the lesions extend to the shoulder region, flap coverage is recommended to prevent wound contraction and restriction of shoulder movements. Very few local/regional options are available for coverage of these extensive soft tissue defects. Free tissue transfer is an alternative option to pedicle flaps. However, there is an increased requirement of operating time, resources, and the risk of total flap loss. The latissimus dorsi myocutaneous flap (LDMF) is a versatile option to cover these defects due to its large vascularized surface area, long vascular pedicle, and less donor site morbidity. The aim of this study is to share our technique and analyze the outcomes in this case series. MethodsRetrospective analysis of seven patients who underwent wide excision of the malignant tumors around the clavicle was done between January 2016 and June 2018. Patient demographics, clinical details, the arc of rotation, outcome, and complications were analyzed. Surgical TechniquesLatissimus dorsi muscle was evaluated by palpating the muscle at the posterior axillary fold while resisting the shoulder adduction during the preoperative workup. Once the malignant lesion was excised and the defect was created by the general surgeon, we took over the patient. The patient was turned into the lateral decubitus position and the latissimus dorsi muscle boundaries were marked. The anterior border of the muscle was marked along the posterior axillary line and the upper border was marked at the tip of the scapula, medially at the spinous process of the vertebra and inferiorly at the posterior aspect of the iliac crest. The skin paddle was designed over the muscle, predominantly over the upper two-thirds of the muscle, to include the high density of myocutaneous perforators. The length and breadth of the defect were noted and Abstract Background: The versatility of pedicled latissimus dorsi (LD) flap is well known for the reconstruction of the breast, upper limb, and trunk defects. Extensive soft tissue defects following oncologic resections around the clavicle are rare and the utility of pedicled LD muscle flap has been less reported.

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“…The orthopedic oncologist coordinated care from preoperative planning to postoperative management and was scrubbed for the entirety of the procedure. This allowed for preoperative placement of an IVC filter and intraoperative closure with an advancement flap, sparing the patient a rotational latissimus flap, which carries the risk of flap failure [ 18 ]. Postoperatively, the decision to COVID-test early on allowed for coordination of care with a dedicated COVID team who had more expertise in treating critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Postoperative COVID-19 Pneumonia following Resection of a Large Thoracic Chondrosarcoma

Kaidi

Held

Park

et al. 2021

Case Reports in Orthopedics

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Case. A 57-year-old man presenting with two months of insidious shoulder pain was found to have a large thoracic chondrosarcoma invading the spinal canal. The patient’s orthopedic oncologist organized an interdisciplinary team including interventional radiology, thoracic surgery, neurosurgery, and plastic surgery. This allowed safe, en bloc tumor resection. The patient’s postoperative course was complicated by COVID-19 pneumonia, which was rapidly identified and medically managed with full recovery. Conclusion. Postoperative COVID-19 pneumonia can present insidiously and mimic other postoperative complications. Early identification and testing can promote rapid isolation, proper personal protective equipment use, and guide outcome-improving treatments.

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

Cited by 9 publications

References 13 publications

Tiger Attack Resulting in a Humeral Defect Treated with Proximal Humeral Replacement and Latissimus Dorsi Flap

Tiger Attack Resulting in a Humeral Defect Treated with Proximal Humeral Replacement and Latissimus Dorsi Flap

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Postoperative COVID-19 Pneumonia following Resection of a Large Thoracic Chondrosarcoma

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