Utility of large V-Y advancement of the latissimus dorsi myocutaneous flap in the reconstruction of large thoracic defects: a case series and literature review

Abstract

BackgroundTrunk reconstruction following sarcoma excision involves significant defects. Pedicled and free latissimus dorsi myocutaneous flap (LDMF) reconstruction is commonly employed for thoracic defects; however, skin paddle design is limited to 10-12 cm to achieve primary donor closure. Paucity of data exists regarding the utility of V-Y advancement of LDMF, previously described for moderately sized thoracic defects. Efficacy of the technique's application, axial reach, maximum skin paddle, and overall success or complications have not been defined in the literature. MethodsA retrospective review of records was conducted from 2015 to 2021 at our center to identify patients who underwent large, islanded V-Y LDMF reconstructions. Results were assessed by reviewing photographs and clinical notes. PubMed search of articles using the search terms “Latissimus Dorsi Flap Reconstruction” AND “V-Y” was conducted, abstracts were screened, and relevant articles were selected for review by the 2 author (NL/YS). We summarized the findings in our review and discussion. ResultsEleven patients underwent V-Y LDMF reconstruction with large skin paddles designed to close the donor site and oncological defect. Flaps were mobilized in superior (n = 7), anterior (n = 2), inferior (n = 1) and medial (n = 1) directions. Satisfactory coverage and patient recovery with few complications was achieved. Average length of hospital stay was 4.7 days and secondary surgery was not required. Discussion and conclusionV-Y advancement of LDMF is reliable up to 24 cm axially with a skin paddle width of 24 cm based superiorly, inferiorly, or anteriorly. The technique is safe and effective in comorbid patients following high-dose radiotherapy, without prolonged general anesthesia or microsurgery. It represents a versatile locoregional reconstructive option for large trunk defects.