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.     

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.     

Endobronchial closure of a postpneumonectomy bronchopleural fistula.

Successful permanent endobronchial closure of a serious postpneumonectomy bronchopleural fistula is reported in a patient with a delayed diagnosis of Mycobacterium fortuitum-cheloni infection. Increasing experience, improved plugging agents, and a review of the literature suggest that in selected patients, this procedure can avoid complex repeat operations and reverse life-threatening situations. Although atypical mycobacterial infections occur with infrequency, they are difficult to treat and may lead, as in this patient, to a misdiagnosis. Operations on granulomatous tissues are prone to heal poorly, thus inviting tissue breakdown and chronic fistulas.     

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.     

The reverse turnover latissimus dorsi flap for closure of midline lumbar defects.

The surgical treatment of wounds located in the median lumbar area is difficult. When occurring after neurosurgical procedures, they may display a high level of complexity because of dural exposure, deep irregular three-dimensional contours, and bacterial contamination of the wound. The difficulty of reconstruction in that region of the body is made greater by the few possible regional flaps available in the vicinity. In order to obtain well-vascularised tissue, with good resistance to bacterial contamination and easy to shape into such defects, the reverse turnover latissimus dorsi flap is a useful surgical option. Between 1998 and 2003, four patients presented with complex lumbar wounds in our department. Three patients were adults (mean age: 63 years) and one patient was 1 year old. In all cases, reconstruction was needed in the lumbar area after surgery on the spine. All wounds presented with bacterial contamination. In three cases, dural exposure was present, while in the fourth case, a small remnant of the posterior vertebral bony lamina was still present after debridement. In all four cases, the reconstruction was successfully achieved by turning over the latissimus dorsi to reach the lumbar midline defect. In one case, the adult paraplegic patient, only the inferior part of the muscle was harvested, to preserve an innervated upper part of the muscle for upper limb function. In the four cases, long term results were excellent (the mean follow up was 3.5 years), with no residual infection.     

Transthoracic closure of a postpneumonectomy bronchopleural fistula with coils and cyanoacrylate

Standard treatment for persistent bronchopleural fistulas involves thoracotomy with primary closure and transposition of a vascularized muscle flap to the bronchial leak site. This major operation may be ineffective or medically contraindicated. We successfully treated 2 patients by insertion of coils and cyanoacrylate glue into and adjacent to the fistula of a postpneumonectomy bronchial stump with computed tomographic-guided transthoracic needle. The coils served as scaffolding for cyanoacrylate glue to control the bronchopleural fistula.     

Combined transthoracic and transtracheal closure of large bronchopleural fistulae

PURPOSE: Postoperative central bronchopleural fistulae (BPF) are difficult to close using percutaneous or endoscopic techniques. We devised an alternative method to treat BPF using a combined transthoracic and transtracheal approach with the use of a multifilamented polypropylene (Prolene) mesh patch. METHODS: Two patients with large, central BPF after thoracic surgery and lobar resection had minimally invasive BPF closure using a transtracheal approach with catheterization of the fistula and thoracoscopically guided Prolene mesh placement over the bronchial stump defect. This technique was adopted after conservative management and multiple endobronchial interventions had failed in both patients. RESULTS: One patient had closure of his BPF within one week and remains symptom-free one year after chest tube removal. The other patient had a BPF and chest tube for two years prior to our procedure. His BPF initially closed, but recannalized 2 weeks later. He subsequently had two thoracotomies and continues to suffer a BPF which remains externalized to his chest wall. CONCLUSIONS: Post-thoracotomy central BPF that is resistant to nonsurgical treatments can be closed with a combined thoracoscopic and transtracheal placement of a polypropylene patch. The success of this repair seems to depend on early intervention and aggressive sterilization of the pleural space.     

Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after posterolateral incision

The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because of empyema with Pseudomonas aeruginosa. Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after a standard posterolateral incision.     

The extended latissimus dorsi muscle island flap for flexion or extension of the fingers

We describe the technique of transferring the latissmus dorsi muscle as an island flap for the restoration of digital flexion or extension in 28 patients. The latissmus dorsi muscle is raised down to the posterior iliac crest and prolonged with the gluteal superficial facia. We believe that this method is particularly suitable for extensive and prolonged paralysis of the lower elements of brachial plexus. It can be used also for severe Volkmann's contracture or the loss of flexor or extensor muscles of the fingers due to extensive debridement. The technique does not require microsurgery and there is no delay in reinnervation of the muscle.     

Repair of postpneumonectomy bronchopleural fistula using pedicled pericardial flap supported by fibrin glue

Effective closure of the postpneumonectomy bronchopleural fistula (PBF) with the use of different techniques still remains a challenge for thoracic surgeons. The aim of this study was to evaluate the efficacy of modified method of PBF closure using pedicled pericardial flap (PPF) supported by fibrin glue (FG). The efficacy of the late PBF closure with the use of two surgical methods was compared. In 10 patients, the edges of the PBF were covered with FG and PPF. In the second group of nine patients, myoplasty was used to close the bronchial fistula. Postsurgical follow‐up was for 1 year. In the first group, the healing of the fistula was achieved in 100% of the cases, whereas in the second, myoplasty group, healing was achieved in only 66·67% of the cases. The number of complications was similar in both groups. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of PBF in selected patients.     

应用岛状背阔肌肌瓣Ⅰ期乳房再造98例的体会

目的 介绍采用侧胸切口岛状背阔肌肌瓣Ⅰ期乳房再造的应用体会.方法 回顾性分析了自2000年1月至2009年6月采用保留乳头、乳晕的乳房改良根治术加岛状背阔肌肌瓣Ⅰ期乳房再造的98例患者的临床资料,阐述其手术要点和常见的并发症.结果 所有患者的再造乳房全部存活,无肌瓣坏死,但少数患者存在供区血清肿和背部畸形等并发症.结论 本术式操作简便,效果确切,Ⅰ期再造的乳房切口隐蔽,外形良好,值得临床推广使用.     

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.