Reconstruction of a large upper arm defect with muscle sparing latissimus dorsi

Abstract

Reconstruction of large soft tissue defects in the upper arm represents a challenge for the reconstructive surgeon. The latissimus dorsi flap is widely used and preferred for this latter type of reconstruction due to its reliability and versatility, although sacrificing the entire muscle can lead to higher incidences of postoperative seroma and functional disability. The recent introduction of the perforator-based flap concept has led to an evolution in upper extremity reconstruction by significantly reducing donor-site morbidity and simultaneously ensuring optimal soft tissues coverage. We report a case of a large soft tissue defect of the posterolateral part of the upper arm, consequent to a sarcoma resection, in which a muscle-sparing latissimus dorsi technique was used to obtain total soft tissue coverage. A 2-year follow-up showed a satisfactory functional result and no evidence of recurrence.

Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute

“…Reconstruction of large arm defects remains challenging for the reconstructive surgeon as local flaps, such as the pedicled lateral arm flap, may be appropriate only for smaller defects. 5 , 8 Pedicled flaps from the trunk, such as the LD flap, and free flaps are more appropriate for large-sized defects, but have disadvantages, such as donor site morbidity, longer operative time, longer postoperative recovery, and higher economic costs. 1 , 8 Among the regional reconstructive options that have been described in the past years, the LD flap was an ideal option for upper arm defects.…”

“… 5 , 8 Pedicled flaps from the trunk, such as the LD flap, and free flaps are more appropriate for large-sized defects, but have disadvantages, such as donor site morbidity, longer operative time, longer postoperative recovery, and higher economic costs. 1 , 8 Among the regional reconstructive options that have been described in the past years, the LD flap was an ideal option for upper arm defects. 2 Although seeming simple to harvest with a reliable and predictable vascular anatomy, the donor site morbidity remains considerable.…”

“… 9 The evolution led to the introduction of the split LD flap in the 1980s by Tobin et al, 10 which was latter popularized by many authors proving the reduction in seroma formation and better functional and aesthetic outcome. 8 …”

“…The evolution led to the introduction of the split LD flap in the 1980s by Tobin et al, 10 which was latter popularized by many authors proving the reduction in seroma formation and better functional and aesthetic outcome. 8 The introduction of perforator-based flaps has significantly led to the reduction of donor site morbidity. 11 Although the thoracodorsal artery perforator flap is an elegant option, there are some drawbacks.…”