Repair of a full-thickness abdominal wall defect with an innervated latissimus dorsi free flap

A 38-year-old man developed an infection that led to necrosis of the abdominal wall after perforation of a gastric ulcer. A split-thickness skin graft over the abdominal viscera was used to achieve temporary primary closure. After full systemic and local stabilisation, it was reconstructed with a free innervated latissimus dorsi myocutaneous flap.     

Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defects

BACKGROUND: Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting. METHODS: The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients. RESULTS: All patients (52-76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm(2), and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns. CONCLUSIONS: Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results.     

Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap

We present a surgical treatment for bladder reconstruction in a case of chronic vesicocutaneous radiation‐induced fistula and reconstruction of the abdominal wall after resection of a liposarcoma in the rectus abdominis muscle. Fistulas are sequelae after radiotherapy. To regain bladder function and reconstitute abdominal wall stability, a microsurgical flap approach should be considered. A male patient underwent resection of a liposarcoma in the rectus abdominis muscle with adjuvant radiotherapy, suffering from a chronic vesicocutaneous fistula. A bipedicled combined latissimus dorsi and serratus anterior flap was carried out after resection of the fistula for reconstruction of the urine bladder and the abdominal wall. Ascending urethrography 4 weeks postoperatively showed no leakage. In the 4‐month follow‐up period, no signs of recurrence of the fistula or herniation occurred. A bipedicled flap allowed reconstruction of the urine bladder and the abdominal wall. Using non‐irradiated, well‐perfused intra‐abdominal muscle tissue over the urine bladder prevented recurrence of the fistula.     

背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形

目的:研究背阔肌游离皮瓣在修复面颈部挛缩畸形中所起的重要作用。方法:10例面颈部瘢痕彻底松解后,采用游离的背阔肌肌皮瓣治疗,将胸背动静脉分别与面动静脉吻合,供瓣区采用中厚皮片移植,其中两例采用预扩张的背阔肌游离皮瓣进行修复。结果:9例背阔肌肌皮瓣游离移植后完全存活,1例背阔肌皮瓣远端部分坏死,术后患者的面颈部功能和外形得到明显的改善。结论:背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形效果可靠。     

Reconstruction after radical hemimaxillectomy using a free multidimensional latissimus dorsi myocutaneous flap

Summary A series of safe, simple and single-staged reconstructions following radical resection of maxillary antral carcinomas with soft tissue involvement is presented. These reconstructions were performed using free triple-folded latissimus dorsi myocutaneous flaps revascularised via the facial vessels. This technique can be safely used in irradiated patients and, when indicated, allows for the administration of early postoperative radiotherapy, thus improving the potential cure rate. Advantages and disadvantages of the technique are discussed.     

The latissimus dorsi muscle flap is useful for the repair of tracheal defects—an experimental study

An experiment was designed to evaluate the limitations of the muscle flap method in treating various locations and sizes of tracheal defects. Five groups of dogs with several types of tracheal defects were prepared. Each defect was covered by the latissimus dorsi muscle flap. Defects of the tracheal membrane (posterior one-third of the tracheal wall) were successfully repaired by the muscle flap without stenosis, even if they extended to 10 rings in length or were situated at the carina. Defects in the posterior one-half of the trachea, up to 5 rings long, were repaired, with minimal stenosis. Defects of the posterior two-thirds, or anterior one-third of the trachea, resulted in marked stenosis following muscle flap repair. Tracheal movement as seen in the saver sheath type of tracheomalasia was observed when anterior support of the trachea was lost. On the other hand, the movement seen in the crescent type of tracheomalasia was observed when posterior support of the trachea was lost. We concluded that a defect of less than the posterior one-half of the trachea can be repaired by muscle flap, without inducing respiratory insufficiency. Therefore, muscle flap coverage for tracheal defects should be a useful technique in the combined resection of the tracheobronchial tree in cases of esophageal cancer.     

应用瓦合式游离背阔肌肌皮瓣修复面中部肿瘤切除术后洞穿性缺损

目的：探讨应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损的方法。方法：对下睑、内眦等面中部复发肿瘤进行扩大根治切除。对于切除肿瘤后形成的洞穿性缺损,应用瓦合式游离背阔肌肌皮瓣进行修复。结果：应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损9例,肌皮瓣全部成活,外形良好。术后半年复查未见局部复发。3例患者于术后半年接受皮瓣去脂术。结论：应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损成功率高,可达到功能和外形同时修复的效果。     

背阔肌岛状皮瓣修复上臂软组织缺损

目的 观察背阔肌岛状皮瓣修复上臂软组织缺损的临床效果。方法 应用背阔肌岛状皮瓣修复１４例上臂软组织缺损。结果 １例皮瓣远端皮肤部分坏死,１３例完成成活。随访４０－６年,受区外形及功能恢复基本满意,供区愈合良好。结论 背阔肌皮瓣由胸背动脉供给血运,该岛状皮瓣具有血供丰富,血管解剖恒定和血管蒂长以及切取容易等优点,带蒂移植适宜修复上臂软组织缺损。     

Expanded reduced latissimus dorsi flap

The reduced latissimus dorsi musculocutaneous flap is a recently reported flap, consisting of a proximal musculocutaneous unit and a distal, thin fasciocutaneous or cutaneous unit. It can be used to obtain satisfactory contour of the recipient site. In cases where a larger and thinner flap is required, we employ pretransfer tissue expansion of the reduced latissimus dorsi flap. Application of the tissue expander appears to increase both the area and the vascularity of the flap. We have so far employed two pedicled and four free-expanded reduced latissimus dorsi flaps in the repair of a variety of defects. All of these flaps survived, and suitable contour, along with primary closure of the donor site, was obtained.     

Abdominal aorta as a recipient artery: Using a free latissimus dorsi myocutaneous flap to close hip and pelvic defects

INTRODUCTIONFree tissue transfer (FTT) is now a common procedure in many surgical centres around the world and it has shown well established results especially in the field of reconstructive surgery. The choice of FTT depends on the size of defect, nature of tissue, length of pedicle and donor site morbidity. Notwithstanding, FTT is complex and always depending on a sufficient recipient vessel.PRESENTATION OF CASEHerein, we report a case in which the abdominal aorta was used as arterial recipient vessel for microvascular transfer of a free latissimus dorsi myocutaneous flap. It was utilized to reconstruct an extensive pelvic and hip defect following a massive gas gangrene with a prior debridement of other potential recipient vessels.DISCUSSIONIn this case, the patient had a large defect that demanded a choice of a large flap such as the free latissimus dorsi myocutaneous flap. The iliac system has been sacrificed during the debridement procedure together with other potential recipient vessels. In the presented case, arterial anastomosis of the free latissimus dorsi myocutaneous flap was performed to the distal part of the aorta without complications.CONCLUSIONUsing the abdominal aorta as a recipient arterial vessel seems to be a reliable alternative that should be considered in difficult reconstructive scenarios such as the “vessel-depleted” pelvis.     

The reverse latissimus dorsi flap for the closure of full thickness defects of the back

Summary The use of the reverse latissimus dorsi myocutaneous flap for the closure of skin defects of the back is reviewed and two case reports are described.     

Donor site morbidity: standard versus partial latissimus dorsi free flap

Over the last 7 years 128 latissimus dorsi free flaps have been performed at the BG Unfallklinik in Murnau. Since 1995, the use of a partial latissimus dorsi, sized according to the defect that has to be covered, leaving a functional remnant has continuously increased. We compared the donor site morbidity after standard and after partial latissimus dorsi flap in a small group of 10 patients each (n=20). The mean follow-up time was 18 and 24 months, the mean age of the patient 42.5 and 43.6 years. The evaluation included complaints, subjective loss of strength, scar length, ROM of the shoulder, and measured loss of strength, taking into account the patient’s dominant side. The acceptance of the donor area by the patients was very good in both groups. It was found that the loss of strength after partial latissimus dorsi is less evident than after standard latissimus dorsi. The scar length was independent of the type of flap chosen. There was no loss in range of movement. In both groups it was found that if the flap was taken from the non-dominant side the difference in strength to the dominant side was more than if the flap was taken from the dominant side. We could not see a causal relationship between age and the amount of strength lost. Because of the decreased donor site morbidity we think the partial latissimus dorsi flap should be used instead of the standard latissimus whenever possible. Received: 9 March 1998 / Accepted: 3 June 1999     

Reconstruction of a large abdominal wall defect resulting after necrotizing fasciitis with free latissimus dorsi flap

Necrotizing fasciitis is a severe, life-threatening infection. When it occurs, rapid and wide debridement of all affected tissues is the mainstay of treatment. We present a case in which a large, full-thickness abdominal wall defect occurred after debridement of a necrotizing fasciitis. The defect was reconstructed using a free latissimus dorsi myocutaneous flap. This large and versatile innervated flap seems to be a promising choice for reconstruction of full thickness abdominal wall defects. Received: 21 April 1999 / Accepted: 29 September 1999     

游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩

目的:探讨游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩的效果。方法:对9例半侧颜面萎缩患者,采用I期行游离背阔肌肌瓣移植,于术后0.5～1年行Ⅱ期自体脂肪填充术。根据面部对称情况行1～3次自体脂肪填充,观察其临床效果。结果:9例肌瓣全部成活,术后0.5～1年观察肌瓣轻度下垂,可见局限性凹陷。经1-3次自体脂肪填充后面部外观明显改善,对称性良好,供区无明显功能障碍。结论:游离背阔肌肌瓣联合自体脂肪填充序列治疗是矫治中、重度半侧颜面萎缩的较好选择,结合不同手术特点的综合治疗,能够显著提高中、重度半侧颜面萎缩的治疗效果。     

修薄的背阔肌肌瓣联合植皮修复足背大面积软组织缺损

目的 探讨修薄的背阔肌肌瓣游离移植联合游离植皮修复足背大面积软组织缺损的应用和治疗效果. 方法 自2005年6月至2011年10月,共收治11例足背皮肤软组织缺损的患者,年龄4-46岁,其中男8例,女3例;早期创伤7例,贴骨瘢痕及陈旧性损伤4例.清创后缺损面积5.0 cm×6.0 cm ～ 8.0 cm× 12.0 cm,均伴有不同程度的肌腱、骨质外露.11例患者均采用修薄的背阔肌肌瓣游离移植联合游离植皮的方法修复创面. 结果 术后肌瓣及移植皮片均成活良好,7例术后随访3～10个月,外形良好,可正常穿鞋,移植皮片质地柔软,稍有色素沉着.结论 选用修薄的肌瓣游离移植表面植皮修复后组织的质地较薄,避免了皮瓣和肌皮瓣移植后臃肿的缺点,是修复足背缺损的较好方法.     

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.     

Free latissimus dorsi and deep epigastric vessels —a good combination for lower abdominal defects

Summary Two cases of extensive loss of the lower abdominal wall, in patients with cutaneous stomas and large surgical wounds, are reported. Local flaps (i.e., rectus abdominis or TFL flaps) were not available or sufficient to repair the defects, therefore a free latissimus dorsi myocutaneous flap was used for the reconstruction in both cases.     

桥式游离背阔肌肌皮瓣在下肢软组织缺损中的应用

目的　观察应用桥式游离背阔肌肌皮瓣修复下肢软组织缺损的效果。　方法　采用桥式游离背阔肌肌皮瓣修复7例下肢严重软组织损伤患者。术前对拟行移植的背阔肌肌皮瓣血管和健肢血管行超声多普勒检查,以确认皮瓣及健肢血管循环良好。清创后,根据创面大小、深度设计皮瓣,用作携带桥的皮瓣长度较双下肢手术部位之间距离长10%左右;供区面积较受区大20%,形成皮管部位的皮肤设计应宽大,避免张力过大对血管造成压迫。然后行皮瓣修复术。观察皮瓣成活情况,总结手术指征及应注意的问题。　结果　7例患者手术后皮瓣均成活。除2例患者因皮瓣较为臃肿行皮瓣修薄术外,其余患者术后外形良好,功能恢复满意。手术指征:患侧肢体一条主要的动脉(胫前或胫后动脉)受损,不宜用另一条动脉作吻合血管行游离皮瓣移植术者;患侧肢体受伤严重,深层组织结构破坏,血管损伤情况不明或估计难以找到受区血管者;对侧健肢的重要血管无损伤者。注意点:术前应考虑桥式皮瓣的血运及断蒂后皮瓣是否能够成活。术后注意皮瓣血运,术区妥善固定。　结论　桥式游离背阔肌肌皮瓣修复下肢软组织缺损效果满意。恰当的创面处理、宽大的皮瓣、稳妥的固定是手术成功的关键。