Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers

A severe form of Volkmann contracture is associated with loss of flexor and extensor compartment muscles. An 11-year-old boy with Volkmann contracture was admitted to our clinics with flexion contracture of the wrist joint and total loss of flexor and extensor muscle functions. Split latissimus dorsi free flap was used for reconstruction. The muscle was split based on the branching of thoracodorsal nerve and artery within the muscle so that each part of the muscle is nourished and innervated by a branch of thoracodorsal nerve and artery. No complication has occurred, and the patient can now grasp objects, although he cannot achieve full range of motion of the fingers. We performed a single muscle transfer for reconstruction of both the extensor and flexor compartments in severe form of Volkmann contracture and omitted the use of a second muscle transfer, thus greatly decreasing the operative time, cost, and morbidity.     

Restoration of elbow flexion by latissimus dorsi myocutaneous or muscle flap

Summary Six patients with flail elbow as a consequence of brachial plexus injury or traumatic loss of arm muscles underwent bipolar transposition of latissimus dorsi myocutaneous or muscle flaps to the biceps brachii to restore elbow flexion. The muscle strength achieved was 1.5–2.5 kg and the total range of active excursion is about 95°. The muscle strength is sufficient to carry out most of the activities of daily life but insufficient to achieve active supination or to perform heavy manual work. Elbow flexion of more than 120° is necessary for the affected hand to reach the mouth and should be one of the goals of the operation. Versatile use of the myocutaneous flap facilitates skin closure and improves the contour of the arm.     

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.     

An extended latissimus dorsi "non-free" flap

A case is reported in which perfusion of a latissimus dorsi musculocutaneous flap was maintained through its secondary blood supply during transfer to a sacral defect, while its thoracodorsal pedicle was being lengthened by saphenous vein grafts. The secondary blood supply was divided only when the microvascular anastomoses were seen to be functioning so this flap was never a truly "free" flap.     

Endoscopic harvesting of the latissimus dorsi muscle flap

The harvesting of the latissimus dorsi flap is performed usually through a large. skin incision. To avoid the associated large scar a minimally invasive technique has been developed for harvesting the latissimus dorsi muscle. To date, this procedure has been used in eight clinical cases. The advantages of the endoscopic procedure are the decrease of visible scarring and the reduction of morbidity at the donor site.     

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.     

Experimental cardioplasty using the latissimus dorsi muscle flap

This study was undertaken to examine the possibility of using the latissimus dorsi muscular flap, divided in two parts thus covering the surfaces of the heart, and inserting it into the thoracic cavity by means of a segmental resection of the second rib. After cadaver case studies, 15 operations were performed on 5 Beagle dogs. The first group of 5 operations consisted of a latissimus dorsi flap graft over the heart. The second group and third group of operations (3 and 6 months later) consisted of reoperating for muscular and cardiac biopsies and electrical stimulation tests on the heart-muscle complex. The latissimus dorsi flap provided a sizable mass of contractile tissue. The haemodynamic studies showed no compressive or constrictive phenomenon of the muscle on the heart and revealed the preservation of an appropriate cardiac output for short intervals of time (2 hours), through phasic electrostimulation of the flap. The histopathological studies showed conserved muscular structure. The technical feasibility, histological adaptability and electrophysiological properties of this muscular flap makes it appropriate to develop a functional stimulation programme and perhaps adequate for the treatment of dysplasic, ischemic, tumoral and other acquired or congenital myocardial diseases.     

The expanded latissimus dorsi flap

The safety of tissue expansion of the latissimus dorsi musculocutaneous flap is confirmed and the advantage of expansion of this flap before transfer illustrated.     

Restoration of elbow flexion by complete latissimus dorsi muscle transposition

Flexor-plasty of the elbow has been performed using either a tubed complete latissimus dorsi muscle or musculocutaneous transposition in eight patients, six of whom had brachial plexus palsy and two traumatic loss of the anterior brachial musculature and overlying soft tissue. The range of follow-up was from one to eight years. When the postoperative results were evaluated according to the criteria of Segal (1959), the results were excellent in four cases and good in three, with one failure. The indications, operative technique and results are discussed.     

Free cutaneous-muscle flap from the latissimus dorsi muscle]

Free cutaneous--muscular flap from the latissimus dorsi muscle was used to cover extensive posttraumatic skin defect of the distal tibia in a patient with lesion of the anterior tibial artery. The technique of flap transfer and vascular anastomosis has been presented. Full healing was achieved.     

Neurotization of the remaining latissimus dorsi muscle following muscle flap transplant

The neurotization of the remaining latissimus dorsi muscle at the donor site is a useful technique in children. It is performed during the same surgical procedure as the free vascularized flap and consists of a neurolysis of the thoracodorsal nerve into three to five fascicles, and introducing them into three to five different openings in the muscle fibers. This technique is important in young patients for avoiding functional long-term sequelae such as scoliosis and developmental muscular defects of the vertebral column. Three cases are reported, with evaluation by electromyography and biopsy.     

The latissimus dorsi flap for breast reconstruction

The major factor limiting reconstruction of major postmastectomy deformities (especially after a radical mastectomy, such as that of Halsted) has been the lack of a satisfactory flap operation. The latissimus dorsal flap fills this need, as it allows a safe one-stage breast reconstruction, with an improved aesthetic result. It should be considered whenever insufficient chest wall skin remains for a satisfactory reconstruction. The author's technique for performing this flap operation is described, having evolved from cadaver dissections and eight clinical cases.     

腹直肌-背阔肌肌皮瓣联合应用乳房再造术

目的　探索一种同时修复乳房和胸壁缺损的手术方法。方法　利用下腹部横行腹直肌肌皮瓣 (下简称TRAM皮瓣 )和部分背阔肌肌皮瓣 ,为乳癌术后患者行乳房再造及胸壁缺损修复。结果　 4例 8个皮瓣全部成活 ,再造乳房及胸壁缺损修复效果满意。结论　联合应用腹直肌—背阔肌肌皮瓣 ,可以同时完成乳房再造及胸壁缺损的修复 ,效果满意。     

The use of the latissimus dorsi muscle as an active motor unit for digital flexion

A technique is described to restore flexion of the fingers and thumb using a latissimus dorsi muscle island as an active motor unit. It has been performed in a ten-year-old child with a satisfactory result.     

Intrathoracic application of the reverse latissimus dorsi muscle flap.

The use of the reverse latissimus dorsi muscle flap based on its paraspinous perforators for posterior trunk wound coverage has been described previously. However, few studies have reported its intrathoracic application. In this study the authors present their experience in treating 3 patients with various intrathoracic defects using the reverse latissimus dorsi muscle flap. There were 1 male and 2 female patients who ranged in age from 4 to 74 years (mean, 49 years). The etiology included an infected aortic graft, a bronchopleural fistula, and a recurrent congenital diaphragmatic hernia. Follow-up ranged from 2 to 24 months. Successful outcomes were achieved in all 3 patients, and there was no recurrence or wound complication identified. Their results demonstrate the versatility and reliability of the reverse latissimus dorsi muscle flap in treating low posterior intrathoracic defects.     

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.