Abstract
Amputation is frequently used to treat malignant tumors invading into the shoulder joint. When the vessels and major nerves of the upper arm are preserved, however, the limb may be salvaged with a combined osseous, myocutaneous flap. We reconstructed large defects, which included the shoulder joint, using a vascularized rib-latissmus dorsi combined flap. Ribs were connected via the ninth or tenth posterior intercostal artery. Several slits were cut in the ribs, and the rib was glass stick fractured to straighten it. The thoracodorsal nerve was preserved and the latissmus dorsi muscle was transferred to the defect previously occupied by the biceps humerus. The ribs were connected to the residual clavicle via a Leeds-Keio artificial ligament. The flaps completely engrafted. The patient was able to flex her elbow relatively early postoperatively. The function of the hand was preserved intact. In conclusion, the combined vascularized rib-latissmus dorsi flap is useful for patients who require functional or bony reconstruction of large defects involving the shoulder joint.
Highlights
Amputation is frequently used to treat malignant tumors invading into the shoulder joint
When the vessels and major nerves of the upper arm are preserved, the limb may be salvaged with a combined osseous, myocutaneous flap
We describe a patient in whom a large defect involving most of the upper arm and glenohumeral joint was reconstructed with the combined vascularized rib-latissmus dorsi flap, resulting in successful limb salvage
Summary
Amputation is frequently used to treat malignant tumors invading into the shoulder joint. In cases where limb salvage is chosen, various tissues including muscle, skin, and bone may be required depending on the extent of the defect. In such cases, flaps based on the thoracodorsal artery will fulfill most of the closure requirements. Large flaps may be created around this artery, which supplies the latissmus dorsi (LD) muscle, serratus anterior muscle, and ribs Flaps from this area may be structured to incorporate varying amounts of bone and muscle as indicated by the defect. We describe a patient in whom a large defect involving most of the upper arm and glenohumeral joint was reconstructed with the combined vascularized rib-latissmus dorsi flap, resulting in successful limb salvage
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