Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle‐splitting free flaps

Chang, Lan Sook; Hwang, Kyu Tae; Park, Seong Oh; Kim, Youn Hwan

doi:10.1002/micr.30828

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…Another advantage of LD flaps is that they offer the possibility of different harvesting options, without positional changes. In our previous reports, we successfully used the supine position and traditional lateral and prone positions for LD flap harvesting (Chang et al, 2022; Kim et al, 2017; Kim et al, 2018; Kim, Youn, Do Kim, et al, 2013; Kim, Youn, Sung, et al, 2013). However, in the present report, the majority of procedures were performed in the supine position without postural changes, with the exception of two cases which involved reconstruction of the popliteal area using popliteal vessels in the prone position.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of soft tissue defect around knee with thoracodorsal artery perforator flap and muscle‐sparing latissimus dorsi flap

Lee

Park

et al. 2023

Microsurgery

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IntroductionAround the knee reconstruction is challenging for reconstructive surgeons. Several methods have been proposed, including perforator and muscle flaps; however, all have advantages and disadvantages. As the success rate of free‐flap surgery increases, reconstruction around the knee using this method is becoming increasingly popular. Nevertheless, there are no large‐scale case reports in the previous literature using either a thoracodorsal artery perforator flap (latissimus dorsi (LD) perforator flap) or a muscle‐sparing latissimus dorsi (msLD) flap for reconstruction around the knee. In this retrospective report, we describe our clinical experiences and present an algorithm regarding recipient vessel choice in free‐flap reconstructive surgery of around the knee defects.Patient and MethodsFifty‐six cases in which a flap from the lateral thoracic area was used to reconstruct an around the knee defect between January 2016 and March 2022 were reviewed. The patients were aged 18–87 years (mean, 52.13 years), and of the 56 patients, 36 were male and 20 were female. Injuries were caused by trauma, contracture, rheumatoid vasculitis, tumor, infection, burns, sunken deformity, and pressure sores. The 56 cases included 22 with a defect including the knee, 14 with a defect below the knee (7 of the primary below‐knee amputation [BKA] and 7 of the secondary BKA), 9 involving the distal medial thigh, 8 involving the distal lateral thigh, 2 involving the popliteal area, and 1 involving the middle thigh. Most cases were reconstructed using a single LD perforator flap or msLD flap. Chimeric or supplementary flaps were used when extensive coverage or dead space obliteration was required. The average size of the defect area was 253.6 cm2 (range: 5 × 6–21 × 39 cm2).ResultsIn the cases, the recipient artery used included the following: descending genicular artery (23), superficial femoral artery (14), descending branch of the lateral circumflex femoral artery (14), anterior tibial artery (2), popliteal artery (2), and posterior tibial artery (1). The recipient vein included the greater saphenous vein (24), descending branch of the lateral circumflex femoral vein (14), superficial femoral vein (7), descending genicular vein (6), anterior tibial vein (2), popliteal vein (2), and posterior tibial vein (1). The average flap size was 281.8 cm2 (range: 4 × 8–35 × 19 cm2). All flaps survived; however, seven complications occurred, including 2 partial flap losses, 1 arterial insufficiency, 1 hematoma, 1 minor dehiscence, 1 donor‐site graft loss, and 1 short BKA. Normal knee range of motion (121–140°) was observed in 34 patients and 16 showed varying degrees of limited range of motion. Motion was not observed in four patients who underwent knee fusion and could not be evaluated in two patients who underwent above‐knee amputation. The mean follow‐up duration was 24.6 months (range: 4–72 months).ConclusionThe LD perforator flap is ideal for the reconstruction of around the knee defects because it enables a long pedicle, large flap, and chimeric design. The msLD flap is ideal because it enables strong stump support, dead‐space obliteration, and infection control. Moreover, since the two flaps are distant from the knee, this method is advantageous in terms of postoperative rehabilitation and there is minimal donor‐site morbidity due to the thin nature of the LD muscle. In addition, the flap can be elevated in three positions and the operation can be completed without positional changes in various recipient vessel locations. Based on our experience, we conclude that the LD flap has the potential to be used as widely as or in preference to the anterolateral thigh flap in the reconstruction of around the knee defects.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of soft tissue defect around knee with thoracodorsal artery perforator flap and muscle‐sparing latissimus dorsi flap

Lee

Park

et al. 2023

Microsurgery

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“…Free parascapular flaps and latissimus dorsi flaps have been used in pressure sore repair 4,8 . However, the parascapular flap is insufficient for closing large defects.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Free parascapular flaps and latissimus dorsi flaps have been used in pressure sore repair. 4,8 However, the parascapular flap is insufficient for closing large defects. In patients with paraplegia, the latissimus dorsi muscle should not be used unless necessary because the patient's movements depend on the function of these muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Free latissimus dorsi myocutaneous flaps alone or in combination with the serratus anterior muscle have been used in the repair of large pressure sores. 4,8 In patients with paraplegia, the latissimus dorsi muscle should not be used unless necessary because the movements of such patients depend on the function of these muscles. 4,6,9 A lower-extremity fillet flap may be a good and rational option for the repair of complex stage IV pressure sores, particularly when the flap is removed from a nonfunctional leg, which limits the mobility of patients with paraplegia.…”

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confidence: 99%

“…Free latissimus dorsi myocutaneous flaps alone or in combination with the serratus anterior muscle have been used in the repair of large pressure sores 4,8 . In patients with paraplegia, the latissimus dorsi muscle should not be used unless necessary because the movements of such patients depend on the function of these muscles 4,6,9 …”

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Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding

Turan

2023

Ann Plast Surg

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Background The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life. Methods We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap. Results No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month. Conclusions These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.

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Advanced Reconstruction in Wound Care

Chen,

Kaya

2023

Pearls and Pitfalls in Skin Ulcer Management

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Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle‐splitting free flaps

Cited by 3 publications

References 27 publications

Reconstruction of soft tissue defect around knee with thoracodorsal artery perforator flap and muscle‐sparing latissimus dorsi flap

Reconstruction of soft tissue defect around knee with thoracodorsal artery perforator flap and muscle‐sparing latissimus dorsi flap

Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding

Advanced Reconstruction in Wound Care

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