Pedicled Latissimus Dorsi Flap for Extensive Scalp Reconstruction in Acute Burns

Abstract

Summary: Extensive full-thickness head and neck burn defects represent some of the greatest challenges because of the exposure of burned calvaria and lack of good local reconstructive options. This study reports the use of a pedicled latissimus dorsi (LD) muscle flap to cover a large full-thickness scalp burn defect measuring 20 × 15 cm, including 15 × 13.7 cm of bone exposure and extending from the posterior neck to the mastoid and vertex of the scalp. The authors discuss the technique to safely maximize the reach, which includes distal dissection to the iliac crest and thoracolumbar fascia, dissection of the pedicle to the axillary vessels, tunnel creation through the pectoralis major muscle, re-attachment of the LD origin to the pectoralis major and teres major, and undermining of the neck skin and subcutaneous tissue to avoid damage of the accessory nerve. This case highlights the reach of a pedicled LD muscle flap for extensive scalp reconstruction for defects all the way to the vertex and beyond. The size and reliability of the LD muscle makes it a valuable alternative for large scalp defects for cases of complex scalp reconstruction in patients deemed not ideal candidates for free flap reconstruction.

Impact of Microsurgical Reconstruction Timing on the Risk of Free Flap Loss in Acute Burns: Systematic Review and Meta-Analysis

“…In this scenario, the transfer of vascularized soft tissue is often necessary to achieve durable coverage and favorable outcomes. 2,3 When skin substitutes and local flaps cannot be considered as an option due to involvement of the tissue surrounding the injury or deemed unsuitable, free flaps may be the only appropriate alternative. Free flaps allow wound coverage in a singlestage procedure, potentially accelerating the healing process and reducing the risks related to prolonged hospitalization, such as infection and wound healing issues.…”

Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis

“…Delayed reconstruction using flaps has emerged as a valuable technique to release severe scar contractures and allow for large scars resurfacing in burn patients. [10][11][12][13][14][15] However, the success rates and complications associated with free flaps in delayed burn reconstruction vary in the existing literature. This poses a challenge to the reconstructive surgeon not only in preoperative planning and surgical decision-making but also in counseling patients and providing them with evidence-based data on different reconstructive options.…”

Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis

“…3 Although soft tissue defects resulting from a burn injury can be managed with local flaps, their application is sometimes limited by the wound size of involvement of local tissues in the zone of injury. 4,5 Free flap reconstruction offers a viable solution for early repair of complex, large defects, particularly when dealing with exposed bone, nerves, or tendons, and when local flaps are unsuitable or contraindicated. 6 However, free flap reconstruction is a challenging and time-consuming procedure, and eligibility for reconstruction depends not only on burn depth and size but also on the patient's clinical status.…”