Oblique latissimus dorsi myocutaneous flap in breast reconstruction

Breast reconstruction with latissimus dorsi myocutaneous flap is a reliable technique. Its width is limited to between 10 and 12 cm if direct closure of the donor site defect is required. We report a study with assessment of the dorsal skin laxity in 25 women, simulating vertical, horizontal and reverse oblique flap. The average width was 12.5 cm (11.6 to 14 cm) for reverse oblique flap, 9.4 cm (8 to 11 cm) for vertical and 9.2 cm (8 to 10.6 cm) for horizontal flap. Our study suggests that the reverse-oblique flap provides a wider flap and reduces the donor site morbidity.     

A case report of cross-leg free latissimus dorsi myocutaneous flap transplantation

One of the significant reconstructive challenges is closure of large soft tissue defects of the lower extremity. A patient with a large traumatic defect in the lower extremity was treated with a cross-leg free latissimus dorsi myocutaneous flap. The size of the flap was 32×12 cm. The pedicle was divided 22 days after the initial operation. The result was satisfactory after a 2-year follow-up. This technique allows the transfer of large flaps to cover compromised wounds, with the advantage of using suitable recipient vessels. Received: 4 March 1998 / Accepted: 25 March 1999     

Intraoral reconstruction with latissimus dorsi myocutaneous island flap

Summary Intraoral reconstruction for large defects using a latissimus dorsi myocutaneous island flap in ten patients is presented. All flaps were transferred successfully in one stage and provided adequate flap tissue for the intraoral defect. Five cases involved hemiglossectomy. The postoperative atrophy of the flap was minor and the intraoral defects were adequately resurfaced. The postoperative function of the remaining tongue was satisfactory. The latissimus dorsai myocutaneous flap was found to be reliable and useful for intraoral reconstruction.     

Entire pharyngoesophageal reconstruction with latissimus dorsi myocutaneous island flap

The entire pharynx and cervical esophagus were reconstructed after total laryngectomy and pharyngoesophagectomy for advanced cancer in 14 patients with the use of a pedicled latissimus dorsi myocutaneous island flap. All flaps were transferred successfully in one stage. The reliability of the flap and postoperative state of food passage were studied. Repair was confirmed by roentgenographic examination 6 months after surgery. A slight narrowness was noted at the portion anastomosed with the esophagus, with dilatation of the reconstructed segment. All patients in our study have been able to resume normal oral feeding. The pedicled latissimus dorsi myocutaneous island flap is reliable and useful for the reconstruction of the pharynx and cervical esophagus.     

Free latissimus dorsi perforator flap for reconstruction of hemifacial atrophy: case report

Progressive hemifacial atrophy (PHA) is characterized by slow and progressive atrophy usually of one side of the face. PHA affects primarily the subcutaneous fat and muscle tissues, but may involve the bone. The cause is unknown. The treatment is symptomatic and directed at augmentation of the deficient soft-tissue volume. The reconstructive procedures may combine fat grafts, dermis fat grafts, pedicle flaps, bone grafts, microvascular free flaps, and alloplastic implants. We report a patient with of PHA whose condition was treated with a free latissimus dorsi (LD) perforator flap. The LD perforator flap was suitable for the large defect of the patient. It could easily be tailored and thinned to follow the facial contour. Minor revisions were needed for esthetic reasons. There was neither significant downward gravitation nor wasting of the flap. 23 months later, the natural appearance of the face was maintained.     

Dealing with the non-healing; donor site defect following latissimus dorsi myocutaneous flap in breast reconstruction

We present two cases of donor site morbidity following immediate breast reconstruction using the extended latissimus dorsi myocutaneous flap. Early post operative dehiscence occurred in both cases, followed by a prolonged period of expectant and conservative management. Plastic surgical intervention involved exploration and removal of significant epithelial lined cavities and reconstruction using local flaps to solve this complication.     

Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese

Objective: Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population. Methods: Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated. Results: Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent (n = 5), good (n = 4) and poor (n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives. Conclusion: Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction.     

Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report

Free muscular, osteomuscular, and fasciocutaneous flaps are widely used for midfoot reconstruction. The latissimus dorsi (LD) flap is rich in muscle mass, but the weight‐bearing ability of the reconstruction with its combination with a scapula or rib has not been evaluated. Here, we report a case of reconstruction of the right midfoot with the trauma‐related osteomyelitis using a free chimeric scapula and LD muscle flap in a 59‐year‐old woman with diabetes mellitus. After radical debridement and sequestrectomy, a 7 × 3 cm² wound with a 5 × 3 cm² bony defect was reconstructed with the chimeric scapula and LD muscle flap. The postoperative course was uneventful. The bony union was achieved 6 months after surgery. In 14 months follow‐up, no clinical complications including a new ulcer or stress fracture were noted. At the end of follow‐up, the gait analysis showed an unbalanced stress distribution on the right foot and a valgus gait. We suggest that this chimeric scapula and LD muscle flap may be an alternative option for midfoot reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.     

Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report

Reconstruction of the perineum and pelvic cavity in continuity is an uncommon and difficult challenge. This case describes a 66-year-old man who presented following recurrence of a Dukes’ B rectosigmoid adenocarcinoma that had been treated nine years previously by anterior resection, 5-fluorouracil and radiotherapy. His recurrent disease was treated with radical pelvic exenteration with formation of an end colostomy and urinary ileal conduit.A post-operative pelvic collection necessitated incisional drainage via the perineum. This resulted in a perineal defect in continuity with the pelvic cavity, neither of which healed in spite of alternate day packing with antiseptic dressings. The perineum and cavity were reconstructed successfully with a microvascular transfer of the latissimus dorsi using the primary gracilis pedicle as recipient donor vessels.     

Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap

Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap.KEY WORDS: Complex defect, reconstruction, tendo-Achille     

The subscapular approach in head and neck reconstruction with the pedicled latissimus dorsi myocutaneous flap.

We have devised a new approach for transferring the pedicled latissimus dorsi myocutaneous flap to the head and neck region, and have applied it successfully in several patients. Our approach is rapid and increases the arc of rotation in order to cover defects of the lower lateral and posterior aspects of the head and neck. The vascular pedicle is protected between the scapula and the rib cage. We have used this approach in 15 patients over the last 9 years with good results.     

Back closure with a latissimus dorsi myocutaneous flap.

A method of back closure with the use of latissimus dorsi myocutaneous flap in cases of myelomeningocele is reported. A three-layer cover consisting of the skin, subcutaneous fat, and the muscle with proper innervation and blood supply of the flap permits successful closure of large defects. Well-vascularized coverage prevents common complications such as partial necrosis of the flap or wound breakdown and consequent infection of the central nervous system. This report is based on 30 cases of newborns with large thoracolumbar myelomeningocele.     

Reverse‐supercharged,distally based latissimus dorsi flap for lumbar defect: A case report

Well‐vascularized tissue is required for successful reconstruction of a soft tissue defect in the lumbar region. There are several options for reconstruction; however, controversy exists regarding the optimal technique. Here, we present a case of a lumbar defect following tumor resection in a 75‐year‐old patient that was repaired using a reverse‐supercharged, distally based latissimus dorsi flap. The defect of size 15 × 12 cm² was localized to the lumbar region. An 11 × 7 cm²‐sized, distally based latissimus dorsi flap was designed cephalad to the latissimus dorsi muscle. After the flap was tunneled to the defect, vascular insufficiency of the skin flap was observed. Supercharging was subsequently performed by anastomosing the serratus anterior branch in a reverse manner to the lumbar perforator. The diameters of the vessels at the end‐to‐end anastomosis site were 1.0 mm (artery) and 1.2 mm (vein), respectively, and there was slight discrepancy in their calibers. After microvascular anastomosis, the vascular supply of the flap improved, and the flap survived uneventfully, without venous congestion. The patient was discharged 17 days after the surgery, and no recurrence of the tumor was observed at the 2‐year follow‐up. We report a case of successful salvage of a distally based latissimus dorsi flap by the reverse‐supercharge technique based on a serratus anterior branch. This flap might be a suitable alternative for use in the lumbar region in the case of limited availability of reconstructive choices.