Triple‐lobe combined latissimus dorsi and scapular flap for reconstruction of a large defect after sarcoma resection

Abstract

Background In the setting of the reconstruction for a large defect, we must make the maximum use of the limited human tissue with the minimum damage. In this article, we report on reconstruction using a combination of three‐skin paddle latissimus dorsi and a scapular flap for a large defect after soft tissue sarcoma resection to minimize donor site morbidity. Methods From 2000 to 2012, six patients underwent primary reconstruction using free or pedicled triple‐lobe combined latissimus dorsi and scapular flap after wide resection of soft tissue sarcoma. There were five male patient and one female, and their average age was 66.8 (range, 49–80 years). The location of the defects was the thoracic wall in three, the thigh in one, the knee in one, and the shoulder in one. The average size of the defect was 18.8 × 13.9 cm. Results The average size of the ascending scapular flap and the skin paddle of the latissimus dorsi flap was 6.8 × 13 cm and 7.3 × 14.7 cm. One patient had partial necrosis of the skin paddle of the latissimus dorsi flap, which was treated conservatively. The triple‐lobe combined latissimus dorsi and scapular flaps survived completely in five cases. Neither anastomosis complications nor infections were encountered. The average follow‐up period was 63.67 months. All patients were satisfied functionally and esthetically with the reconstruction outcomes at the end of follow‐up. Conclusion In conclusion, the triple‐lobe combined latissimus dorsi and scapular flap is one of the options for reconstruction of a large defect after sarcoma resection to minimize donor site morbidity.

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

“…However, the LD flap has the advantages of a large flap size, less susceptibility to infection, and the recurrence of osteomyelitis, which should be considered in limb salvage surgery (Germann et al, 2006; Kawakatsu et al, 2010; Qu et al, 2012; Tan et al, 2007). Although the triple lobe combined LD and scapular flap have been reported for the reconstruction of a large defect just with one micro‐anastomosis and less risk of combination than the pre‐fabricated chimeric flap, the aesthetic appearance still needs much improvement if it is used to cover soft tissue defects in the plantar and dorsal surface of the foot (Karakawa et al, 2021; Mahajan et al, 2018).…”

Multiple Flap Transfer for Multiple Local Recurrence of Soft Tissue Sarcoma

“…While smaller defects can be addressed with primary closure, larger ones necessitate more advanced plastic and reconstructive surgery techniques, such as local or free flap transfers. These reconstruction techniques have been explored extensively in the academic literature [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. With the current improvements in microsurgical techniques and instruments, some recent studies have shown that free flap transfers have a similar safety profile to the reconstruction using a local flap [ 2 , 3 , 10 ].…”

Multiple free dorsal flaps for symmetrical peripheral gangrene of the extremities: A case report

“…There have been several reports of combined scapular and latissimus dorsi flaps. 1 , 2 However, there has been no report of elevation of these flaps in multi-stage operations. We report a case of symmetrical necrosis of the extremities due to acute infectious purpura fulminans in which four amputated stumps were reconstructed by the bilateral thoracodorsal artery flaps and scapular circumflex artery flaps in multiple stages.…”