Scapulectomy with latissimus dorsi musculocutaneous flap in the treatment of sarcoma of the upper back

We present a patient in whom scapulectomy was performed to treat a huge malignant fibrous hystiocytoma of the back. Computed tomographic examination showed the tumor to have invaded the musculature of the upper back and about the scapula. To achieve adequate surgical excision, a major portion of the skin and soft tissue of the upper back was excised in conjunction with subtotal scapulectomy. The defect, with exposed vertebral spines and transected scapula, was covered with an ipsilateral latissimus dorsi musculocutaneous flap. Now, four years postoperatively, the patient has no evidence of recurrent disease and has good use of his arm. Total or partial excision of the scapula is rarely performed and poses unique problems. As our case demonstrates, scapulectomy (combined with musculocutaneous flap) is well tolerated, and surgeons should not be discouraged from using it when appropriate.     

Total phalloplasty using a musculocutaneous latissimus dorsi flap

OBJECTIVE: To present total phalloplasty in children and adults using a musculocutaneous latissimus dorsi (MLD) free flap to create a large neophallus, that allows easy urethroplasty and implantation of a prosthesis. PATIENTS AND METHODS: From April 1999 to January 2006, 16 patients (mean age 24 years, range 10-34) had a total phalloplasty; the indications were congenital anomalies of the penis in 12, iatrogenic in two and accidental penile trauma in two. The MLD flap is mobilized on a subscapular artery and vein, and a thoracodorsal nerve. The neophallus is created on-site and after dividing the neurovascular pedicle, transferred to the pubic region, where it is anastomosed with the femoral artery, saphenous vein and ilio-inguinal nerve. The donor site was closed directly in 15 patients while in one a split-thickness skin graft was used to cover the defect. In the following stages, two- or three-stage buccal mucosa urethroplasty was used in 11 patients; a penile prosthesis was implanted in seven. RESULTS: The mean (range) follow-up was 31 (12-74) months; the penis was 14-18 cm long and 11-15 cm in circumference. There was no partial or total flap necrosis; the donor site healed satisfactorily in 13 patients while in the remaining three there was moderate scarring. The patency of the urethra was good in all patients. Two urethrocutaneous fistulae developed; one closed spontaneously and the other was successfully treated with minor surgery. The function of the implanted penile prostheses was satisfactory in all patients. CONCLUSIONS: The MLD flap allows the creation of a neophallus of good size and with a good aesthetic appearance; it allows urethroplasty and safe implantation of a penile prosthesis, and it can also be used in children.     

Combined latissimus dorsi musculocutaneous flap and free superior gluteal artery skin flap.

We used a combined superior gluteal artery skin flap and latissimus dorsi musculocutaneous flap to repair a massive tissue defect of the upper limb. This combined flap has several advantages in that the length can be more than 60 cm, it can be used as an auxilliary muscle (latissimus dorsi) and it can also be used as a sensory flap. This combined flap is useful for covering massive skin defects.     

背阔肌肌皮瓣移植修复上肢大面积复合组织缺损

目的　探讨应用背阔肌肌皮瓣修复上肢大面积复合组织缺损的疗效。方法　用带蒂背阔肌肌皮瓣修复上肢皮肤肌肉缺损 3例 ,并重建肱二头肌和肱三头肌功能 ;游离背阔肌肌皮瓣修复上肢皮肤肌肉缺损 9例 ,其中 3例将胸背神经与桡神经缝合 ,另 6例将胸背神经与正中神经缝合。皮瓣切取面积为 7～ 15cm× 18～ 42cm。结果　 12例皮瓣全部存活 ,4例肌力恢复至M4,6例恢复到M3 ,2例为M3 -。结论　应用背阔肌肌皮瓣修复上肢大面积皮肤、肌肉缺损时 ,能恢复伸屈肘关节的功能及大部分伸屈手指的功能。     

Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

ObjectiveTo report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps.MethodsSix patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cmx6 cm to 30 cmx18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi-mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery.ResultsAll flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh) or was closed primarily (3 cases) and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.ConclusionOur experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.     

Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap

ObjectiveTo analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction.Patients and methodsProspective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months.ResultsThe reconstructed and healthy breasts decreased in volume in group 1 (?45.85 cm³ ± 48.41 cm³, p = 0.0004; ?29.13 cm³ ± 14.98 cm³, p = 0.0009) and in group 2 (?31.5 cm³ ± 25.35 cm³, p = 0.0001; ?15.4 cm³ ± 21.96 cm³, p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05).Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001).ConclusionWe suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast.     

Anterior mediastinal tracheostomy with a latissimus dorsi musculocutaneous flap.

We describe the reconstruction of an anterior mediastinal tracheostomy with a latissimus dorsi musculocutaneous flap. This procedure is safer, more easily carried out, a more reliable means of creating an anterior mediastinal tracheostomy and is better suited for chest wound healing than previous methods. In addition, the appearance of the patient's chest after operation is cosmetically excellent.     

Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps

An urgent closure of myelomeningocele defects was carried out in 82 newborns using latissimus and/or trapezius musculocutaneous advancement flaps. A three-layer closure of skin, muscle, and fascia was achieved in a single stage without a flank skin graft. All of the wounds healed within a two-week period and no late breakdown of the wound occurred during the eight-year period of study. The urgent closure maximized the neurological salvage and facilitated early cerebrospinal fluid shunting by preventing both infection and neural desiccation. This report represents the largest number of sequentially treated myelomeningocele defects without a major wound healing problem or death. The advancement musculocutaneous flap closure is safe, simple, and effective and is recommended as the preferred method for closure of the myelomeningocele defect.     

Reconstruction of large chest wall defects using a combination of a contralateral latissimus dorsi and a rectus abdominis musculocutaneous flap.

A combination of a contralateral latissimus dorsi musculocutaneous flap and a rectus abdominis musculocutaneous flap used in the reconstruction of large chest wall defects is reported in three patients. This combination is an easy and reliable procedure, without microsurgery, for reconstructing large chest wall defects or deformities and is applicable to patients whose ipsilateral branches of the subclavicular and axillary vessels cannot be used, and to those who need reconstruction of the subclavicular area and axilla as well as the breast mound area.     

Functional latissimus dorsi island pedicle musculocutaneous flap to restore finger function

Functional latissimus dorsi island pedicle musculocutaneous flaps were used to restore flexion or extension of the wrist and digits in four clinical cases. By retaining the fascial origin of the latissimus dorsi from the posterior crest of the ilium, the entire muscle was transferred without dividing its neurovascular pedicle and microneurovascular anastomoses. Its facial origin successfully reached the finger flexor or extensor muscles of the forearm. The latissimus dorsi muscle was sutured to the digital flexor tendons in three patients and connected to the extensor tendons in one patient. All transfers restored active finger flexion or extension.     

带蒂背阔肌皮瓣修复锁骨区恶性肿瘤切除术后皮肤软组织缺损

目的 探讨带蒂背阔肌皮瓣在修复锁骨区恶性肿瘤切除术后皮肤软组织巨大缺损的疗效.方法 对2015年11月-2018年1月收治的9例锁骨区恶性肿瘤患者,术前常规穿刺病检,病检结果证实后手术扩大切除,切除后所形成的巨大缺损创面采用带蒂背阔肌皮瓣进行修复.结果 术后经15～24个月随访,皮瓣全部成活,供区均一期愈合.近、远期随...     

Correction of pectus excavatum with free latissimus dorsi musculocutaneous flap

The treatment of pectus excavatum in an adult patient using a free de-epithelialized latissimus dorsi myocutaneous flap is described. While sternal elevation has been a standard method for the treatment of pectus excavatum, the procedure proposed herein is an appropriate option for patients with mild pectus excavatum who want to avoid invasive surgery and return to daily activities as soon as possible. Received: 24 June 1998 / Accepted: 8 December 1998     

带背阔肌的胸背动脉血流桥接皮瓣重建前臂屈肌功能

 目的 探讨带背阔肌的胸背动脉血流桥接皮瓣重建前臂屈指及屈拇功能的方法及疗效。方法 回顾性分析2011年3月至2013年2月治疗9例前臂损伤患者资料,男5例,女4例;年龄22~57岁,平均39.2岁;均为复合组织缺损;手指屈曲受限,创面最小为15 cm×6 cm,最大为21 cm×9 cm;移植皮瓣面积最小为17 cm×7 cm,最大为24 cm×10 cm。采用带背阔肌的胸背动脉皮瓣移植并桥接动脉缺损,将胸背动脉主干、远端分支分别与受区动脉近、远断端行端-端吻合;胸背动脉伴行静脉(7例为2支,2例为1支)与受区浅静脉(或伴行静脉)行端-端吻合;胸背神经与正中神经肌支行端-端吻合。术后6、12个月对移植肌肉行肌电图及屈肌抓力检查,对皮瓣外形及功能满意度行问卷调查,对患肢功能行Enneking评分。 结果 术后7例获得随访,随访时间12~24个月,患者对皮瓣外形及功能均满意。术后3个月移植肌肉可触及轻收缩,肌电图最大收缩呈单纯相;6个月时呈混合相,2～5指平均抓力为(8.97±2.91) g/mm²,拇指与示指捏力为(1.39±0.22g/mm²;12个月时呈干扰相,2~5指平均抓力为(11.69±3.71) g/mm²,拇指与示指捏力为(1.67±0.34)g/mm²;运动神经功能检查与评定分级,4例M3⁺、3例M3;Enneking评分为正常侧65.7%±15.9%。 结论 吻合血管的带背阔肌的胸背动脉皮瓣可以通过血流桥接的方式移植,可恢复3级以上的屈指功能,并能重建肢体血运,是一种良好的肌肉功能重建术式。     

Patients' satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap

Abstract

Immediate breast reconstruction with a latissimus dorsi musculocutaneous (LDM) flap is still not much reported, particularly in studies of patients' views. The aim of this study was to assess the level of patients' satisfaction with the technique. All patients (n = 257) who had had a mastectomy and immediate breast reconstruction with a LDM flap at a single hospital between January 1999 and December 2005 were identified, and 196 patients free of recurrence were included. The operations were done by the same surgical team in a standard manner. Clinical data, technical details, and outcome were collected prospectively. To assess the patients' degree of satisfaction with the aesthetic results in relation to clinical characteristics and treatment, a study-specific questionnaire and a visual analogue scale were sent to 196 patients; 178 forms were completed and returned. To analyse general satisfaction and aesthetic results we used the Mann-Whitney, Kruskal-Wallis, chi square, or Fisher's exact test, as appropriate. The median reconstruction follow-up period was 34 months. Patients who were 51 years or older at the time of reconstruction were less likely to opt for immediate breast reconstruction with LDM flap than younger patients. Patients who were divorced and those who had postoperative complications were less likely to be satisfied. One hundred and sixty-four patients (92%) were satisfied, and 161 (90%) said they would recommend the reconstruction. The median satisfaction score was 9 (range 1-10, mean 8.5). The technique provided satisfactory immediate breast reconstruction according to the patients' evaluation.     

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.     

Brachial plexus injury after transfer of free Iatissimus dorsi musculocutaneous flap

Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter.