D106. Outcomes of Calvarial and Soft Tissue Reconstruction with Latissimus Dorsi Rib Osteomyocutaneous Free Flap

Abstract

PURPOSE: The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, we aim to present patient-reported and clinical outcomes for patients treated with LDRF. METHODS: An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoraco-dorsal and intercostal system. An IRB-approved retrospective review of ten patients who underwent LDRF and one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurological and functional status were evaluated. One-way analysis of variance (ANOVA) and post hoc Tukey’s tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t-tests. RESULTS: The 10th rib (4.65± 2.01) followed by 9th rib (3.7±1.63) had the highest number of perforators. A combination of the 9th and 11th ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both pre and postoperative questionnaires; Median clinical follow-up was 48 [34-70] months. Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale (p=0.22), Functional Independence Measure (FIM; Motor p=0.52, Cognitive p=0.55), and Headache Disability Index (p=0.38). The minimum clinically important difference (MCID) was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test (SFMA). CONCLUSION: The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects.