Enhancing Viability of the Muscle-Sparing Latissimus Dorsi Flap

Abstract

Aim:The aim of this study is to enhance the viability of the muscle-sparing latissimus dorsi flap. In this study, the muscle-sparing latissimus dorsi myocutaneous flap was designed with the skin paddle of the flap over the distal perforators of the thoracodorsal artery and perforators of the 10th or 11th posterior intercostal arteries. The flap was elevated together with the deep fascia at the base. Methods: Sixteen flaps were used for the repair of defects in different regions in 14 patients, five female and nine male, with a mean age of 45 years. Flap sizes vary from 9x21 to 14x27 cm. The defects were located in anterior thoracic wall in patient four, arm in patient three, axillary fossa in patient three, deltopectoral region in patient two and posterior thoracic wall in patient two. The mean follow-up period was 13 months. Result: All flaps survived without total or partial loss. Seroma or contour deformity in the donor area did not develop. A visible scar developed in the donor area in a patient. Flap thinning was performed on two flaps. In all patients, shoulder joint function returned to normal in the last months postoperatively. Conclusions: If the muscle-sparing latissimus dorsi flap is prepared to include the skin paddle 10th or 11th posterior intercostal arteries and together with the deep fasciae (dorsal thoracic fascia and scarpa’s fascia), it can be safely elevated large sizes.