Thoracodorsal versus reversed mobilisation of the latissimus dorsi muscle for intrathoracic transposition☆

Abstract

The objective of our study is to perform a comparative analysis of the mobilisation of latissimus dorsi (LD) muscle flap using the primary versus secondary blood supply. Between 1 January 2003 and 1 March 2009 we used the LD muscle flap in 57 patients with different intrathoracic suppurations; these patients were divided according to the blood supply used for flap mobilisation. Group A consists of 26 patients in whom the LD was mobilised based on the thoracodorsal vessels (alone in eight patients, in combination with other flaps in 18 patients). Group B consists of 31 patients in whom the LD was mobilised based on the perforator branches from the last intercostals and lumbar vessels (alone in nine patients, in combination with other flaps in 22 patients). Statistical analysis was performed using the GraphPad Prism 5 and EpiInfo 3.5.1 for Windows software. The two groups were similar in age, sex distribution, incidence of tuberculosis, bronchial fistula, postoperative empyema and co-morbidities (p>0.05). We found no statistically significant difference between group A and group B in terms of operative time group (176 ± 33 min vs group B 170 ± 40 min), mortality (4% vs 3%), infection recurrence (8% vs 3%), incidence of minor local complications (8% vs 6%) or hospitalisation 39 ± 16 days versus 41 ± 16 days (p>0.05 for all the parameters). We encountered no significant functional sequelae in any of the 57 patients. Both modalities of mobilisation of the LD muscle flap are safe and allow easy transposition in any part of the chest; the choice of how to use this flap should be made based only on the location of the intrathoracic defect.