Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

Abstract

The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities.Methods: From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm  10 cm to 37 cm  21 cm. Forty-one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty-eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single-and double-wing extended LD flaps were designed and harvested according to the shape of the wounds. Results:The flaps received consisted of 64 single-wing and eight double-wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re-exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow-up was 15.7 months (range, 10-56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow-up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion:Single-and double-wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results.

Ortho‐oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft‐tissue defects after oncologic resections

“…One‐hundred‐fourteen full‐text articles were assessed for eligibility. Seventy of these were excluded and the remaining forty‐four have been divided based on type of technique reported: local flaps (Liu et al, 2014; Masquelet et al, 1992; Nguyen et al, 2023; Ring et al, 2016; Woo et al, 2022; Zelken & Lin, 2016), free flaps (Akdag et al, 2018; Battiston et al, 2015; Calotta et al, 2018; Cherubino et al, 2020; Colterjohn et al, 1997; He et al, 2022; Kim et al, 2021; Kozusko et al, 2019; Medina 3rd et al, 2014; Musharafieh et al, 2001; Namdar et al, 2010; Nosrati et al, 2012; Periasamy et al, 2023; Sailon et al, 2009; Sayyed et al, 2022; Ulusal et al, 2005; Yu et al, 2021), perforator flaps (D'Arpa et al, 2014; Ellabban et al, 2020; Khan et al, 2020; Kwon et al, 2021; Lee et al, 2017; Li et al, 2021; Lin et al, 2021; Pignatti et al, 2011; Ring et al, 2016; Toia et al, 2017), skin grafts (Asif et al, 2018; Kang et al, 2019; Leclère & Casoli, 2016; Schneider et al, 2009; Shimizu & Kishi, 2012) and free bone (fibula) or osteocutaneous transfer (de Boer et al, 1990; El‐Gammal et al, 2002; Han et al, 1992; Toma et al, 2007).…”

“…In cases where local flaps cannot be utilized due to tissue damage or the size of the defect, free flaps are employed. In the context of the foot, the free latissimus flap is a suitable option for both the weight‐bearing plantar surface and the nonweight bearing dorsum (He et al, 2022). The free latissimus flap is particularly advantageous for lower extremity reconstruction over weight‐bearing surfaces such as the heel, owing to its durability and high survival rate (Namdar et al, 2010).…”

Mapping of Thoracodorsal Artery Perforators: Accuracy of Thermography and Handheld Doppler

“…The latissimus dorsi flap, introduced by Tansini in 1906, 1 is a versatile and reliable flap, commonly used in reconstructive surgery in both a pedicled and free fashion. The unique size of the muscle allows to cover large soft tissue defects, 2 challenging plastic and reconstructive surgeons. The thoracodorsal artery (TDA) provides blood supply and splits into a descending, lateral and a transverse branch.…”

“…11 12 13 14 15 Variations such as the extended latissimus dorsi flap further expand the flaps' versatility. 2…”

“…[11][12][13][14][15] Variations such as the extended latissimus dorsi flap further expand the flaps' versatility. 2 Preoperative perforator mapping is essential in TDAP flap planning, 16 can increase the safety of skin perfusion in musculocutaneous flaps, 17 and can speed up preparation in the case of perforator-based temporary latissimus dorsi flap skin paddles and TDAP flaps. 18,19 The acceleration of dissection due to preoperative perforator mapping has also been proven in anterolateral thigh (ALT) flaps and deep inferior epigastric perforator (DIEP) flaps.…”