Reconstruction of a high-energy penetrating injury from the abdomen to the sacral area using a latissimus dorsi free flap with monofilament polypropylene mesh and pedicled flap rotation: a case report

Abstract

A 50-year-old man was transferred to a level I trauma center for penetrating injury. Industrial metal had penetrated his trunk, and he was injured in internal organs. The injured internal organs were treated by the trauma surgery team. The peritoneum was reconstructed with artificial dermal matrix graft. The wound was managed with negative-pressure wound therapy, and several debridement procedures were performed. The full-thickness abdominal defect was covered with monofilament polypropylene mesh(Parietene mesh, 30×30 cm). A latissimus dorsi flap was elevated with a musculocutaneous flap measured 50×30 cm, and 6-cm thoracodorsal artery pedicle. Microvascular anastomosis was performed using the thoracodorsal and left femoral arteries. Two weeks later, we performed local flap rotation based on gluteal artery perforator in the sacral area. Polypropylene mesh was successfully inserted without complications. Combining a latissimus dorsi free flap on a polypropylene mesh can be an effective method for reconstructing large penetrating wounds on the trunk.

Reconstruction of an abdominal wall defect using a latissimus dorsi musculocutaneous free flap after high-intensity focused ultrasound: a case report

“…The reconstruction of large full-thickness abdominal wall defects is challenging for reconstruction surgeons. The goals of abdominal wall reconstruction are to re-establish the integrity of the myofascial layer and provide external cutaneous coverage [3,6]. In our case, the patient's abdominal wall defect was particularly challenging due to the large size of the composite defect involving the rectus abdominis muscle.…”