The Pedicled Latissimus Dorsi Flap for Shoulder Reconstruction After Sarcoma Resection

Abstract

Tumor extirpation around the shoulder can result in large defects requiring coverage of allograft-alloprosthetic constructs and vital neurovascular structures. This study examined a single institution's experience with the pedicled latissimus dorsi flap in reconstructing large shoulder defects after oncologic resection. Using a prospectively maintained database, 33 consecutive patients were reviewed who had undergone a pedicled latissimus dorsi flap to reconstruct oncologic shoulder defects between 1994 and 2004. Wide excision or radical en-bloc resection of shoulder tissues was performed with defects often extending intra-articularly and to the level of the mid-arm. Patient demographics, comorbid conditions, pathology, adjuvant treatment, defect characteristics, skin paddle dimensions and operative records were evaluated. Outcome variables included major and minor complications, patient survival, and limb viability. Adjuvant therapy included chemotherapy in 18 patients, radiation therapy in 12 patients, and brachytherapy in 2 patients. Defects averaged 280.1 cm2 (range 18-1,225 cm2). Mean skin paddle surface area was 118.9 cm2 (range 21-350 cm2). There were 28 myocutaneous flaps and 5 muscle flaps. Materials for bony reconstruction included 13 allograft and alloprosthetic composites, 6 metallic prostheses, and 3 reconstructions using allograft alone. Two patients experienced partial skin flap necrosis. One patient developed local recurrence. Two patients required combined flaps. Use of the pedicled latissimus dorsi flap in complex shoulder reconstructions provided ample well-vascularized soft tissue, minimized risk of infection, and maximized limb salvage. In our experience, the pedicled latissimus dorsi flap is an excellent choice for reconstruction of defects around the shoulder after tumor extirpation.