Free Latissimus Dorsi Musculocutaneous Flap Research Articles

Outcomes and Complications of Sole Reconstruction Using Lateral Thoracic Free Tissue Transfer.

The complex structure of the sole of the foot makes the repair of extensive defects challenging. The present study, therefore, aimed to address a gap in current research by evaluating the potential of the lateral thoracic free flap, including perforator options and chimeric configurations, to be used as an advanced solution for comprehensive sole reconstruction. We retrospectively collected the following data from the charts of patients with sole defects, due to various causes, who underwent lateral thoracic free tissue transfers: patient demographics; etiologies; comorbidities; flap types and dimensions; pedicle length; operative time; follow-up period; complications; and management. The present study included 54 patients who underwent lateral thoracic free tissue transfer, citing infection, trauma, tumor, and posttraumatic sequelae as the major etiologies. We used the following techniques for the reconstruction of sole defects: thoracodorsal artery perforator free flap (83.3%); latissimus dorsi musculocutaneous free flap (1.9%); and various chimeric pattern flaps (14.8%). Free tissue transfer in the lateral thoracic region offers versatility for reconstruction, as well as low donor site morbidity. Complications observed in the present study included wound dehiscence (9.3%), partial necrosis (9.3%), and pressure ulcers (22.2%), although most patients healed favorably without flap loss. The lateral thoracic free flap is a viable option for the reconstruction of the sole of the foot and allows for the effective reconstruction of complex defects. It contains a sustainable skin paddle, and multiple components can be easily included as a chimeric type. Further studies should seek to identify ways to prevent pressure ulcers, which was the only known long-term complication in the present study.

Reconstruction of an abdominal wall defect using a latissimus dorsi musculocutaneous free flap after high-intensity focused ultrasound: a case report

High-intensity focused ultrasound (HIFU) ablation is a safe and effective minimally invasive option for treating uterine fibromas, but it can cause complications such as abdominal wall defects. Reconstruction of such defects can be challenging, but a latissimus dorsi musculocutaneous free flap can be used to restore the integrity of the myofascial layer and provide external cutaneous coverage. Herein, we present a case report of a 37-year-old woman who underwent HIFU for an 8-cm uterine fibroma and subsequently developed a large abdominal wall defect with necrosis of the rectus muscle. The latissimus dorsi musculocutaneous free flap was used to reconstruct the rectus muscle and cover the abdominal soft tissue, resulting in successful engraftment without complications. We present our experience using a latissimus dorsi musculocutaneous free flap to reconstruct a large HIFU-induced composite defect in the abdominal wall.

Two stages of salvaging an extensively necrotic foot with chronic limb‐threatening ischemia by arterialization of great saphenous vein and free latissimus dorsi musculocutaneous flap transfer for wound coverage with the arterialized vein as the recipient vessel: A case report

Patients with chronic limb-threatening ischemia (CLTI) without other options for adequate arterial revascularization could undergo deep (or distal) venous arterialization for limb salvage. Additionally, patients with extensive foot wound with CLTI sometimes require free flap transfer for limb salvage. We herein report a case of successful reconstructive limb-salvage surgery for an extensively necrotic foot with CLTI, using a two-stage operation involving venous arterialization using foot-perforating veins and subsequent free flap transfer (with preservation of the arterialized vein). The patient was a 59-year-old man with CLTI. The patient's right foot had dry necrotic tissue after Lisfranc joint amputation. Only one straight-line to the posterior tibial artery was achieved after endovascular therapies (four times). At the first stage of surgery, an arterial-venous shunt bypass from the superficial femoral artery to the distal great saphenous vein (GSV) (near the foot-perforating vein) was created. Arterial blood supply reached the necrotic area via the foot venous circulation system. At the second stage of surgery, free latissimus dorsi musculocutaneous flap (8 × 27 cm) transfer with preservation of the arterialized vein was performed. The pedicle artery was anastomosed to the bypass graft (end-to-side). The pedicle vein was anastomosed to the proximal stump of the GSV (end-to-end). The flap and residual foot survived completely, at a one-year follow-up postoperatively. An indocyanine green bypass-through angiography revealed the angiosome through the venous arterialization bypass graft, which included the flap; entire forefoot; and partial regions of the midfoot and heel. This two-stage operation might be considered a useful option for limb-salvage and complete wound-healing in patients with severe non-healing wound with CLTI. The two methods could compensate and overcome the problems of either method: incomplete wound-healing after venous arterialization, and the absence of a recipient artery for free flap transfer.

A Case of Multiple Radiation-related Complications during Long-term Follow-up after Sacral Ulcer Surgery

We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.

Cranioplasty Using Three-Dimensional-Printed Polycaprolactone Implant and Free Latissimus Dorsi Musculocutaneous Flap in a Patient with Repeated Wound Problem following Titanium Cranioplasty.

Titanium mesh is an alloplastic material widely used for the reconstruction of moderate-to-large skull defects. Repeated wound problems or infection following these reconstructions inevitably lead to the replacement of the cranioplasty material. Among the various alloplastic materials, polycaprolactone implants are usually used for the coverage of small defects such as burr holes. 1 Herein, we present a case of a large cranial defect successfully reconstructed with three-dimensional-printed polycaprolactone implant and a free latissimus dorsi musculocutaneous flap. Until 1-year follow-up, the patient showed a favorable esthetic outcome with no complications or wound relapse.

Musculocutaneous latissimus dorsi free flap phalloplasty model in pigs - learning tool for genito-urinary reconstructive surgeons

Musculocutaneous latissimus dorsi free flap phalloplasty model in pigs - learning tool for genito-urinary reconstructive surgeons

Musculocutaneous latissimus dorsi free flap phalloplasty model in pigs - learning tool for genito-urinary reconstructive surgeons

Musculocutaneous latissimus dorsi free flap phalloplasty model in pigs - learning tool for genito-urinary reconstructive surgeons

Scalp Reconstruction and Cranioplasty using the Latissimus Dorsi Musculocutaneous Flap in a Patient with Recurrent Wound Dehiscence Accompanied by MRSA Infection

The latissimus dorsi flap has high vascularity and is helpful for the reconstruction of infected areas. Herein, we present a patient with recurrent infections and soft-tissue defects who underwent cranial reconstruction using a free latissimus dorsi flap. The patient had undergone craniectomy and reconstruction using alloplastic bone 18 years previously. A scalp defect accompanied by infection occurred five years ago, and patient underwent reconstruction using a free flap at another hospital; however, the problem persisted. After debridement and bone flap removal, the right latissimus dorsi musculocutaneous flap was elevated, and the thoracodorsal artery and vein were anastomosed end-to-end to the right superficial temporal artery and vein. Methicillin-resistant Staphylococcus aureus was eradicated, and the flap survived. Cranioplasty was performed eight months later, and one year follow-up proceeded without complications. Effective reconstruction and cranioplasty are possible using the free latissimus dorsi musculocutaneous flap, even on scalp with persistent infections and soft-tissue defects.

Vaginal reconstruction: Progress by perforator flaps

ABSTRACT Introduction Gracilis and rectus abdominis myocutaneous flaps have been used for reconstruction of a wide range of vaginal defects, but recently, minimally invasive reconstruction with various perforator flaps has become popular. Vaginal reconstruction for the past 41 years is reported. Patients Summary 15 cases of vaginal defects were surgically treated. The case was that the age at surgery was 23 to 87 years, with an average of 55 years. The original disease is vesico-vaginal fistula 6 cases, Paget cancer 4 cases, labial1 cancer 1 case, pudendal radiation ulcer associated with lymphedema 1 case, Rokitansky syndrome 1 case, GID (Male to female)1 case, vaginal stenosis 1 case. Flaps for reconstruction are: gracilis musculocutaneous flap 5, superficial circumflex artery perforators (SCIP) flap 4, pudendal artery perforator flap 3, medial femoral perforator Flap 2, scrotal flap 1, gracilis perforator flap 1, free latissimus dorsi musculocutaneous flap 1. Reconstruction using multiple flaps was performed for extremely widespread defects. Results and Conclusion Postoperative follow-up was 2weeks to 20 years with an average of 2.5 years. As complications, recurrence of bladder-vaginal fistula occurred in 2 of 6 cases (33%), and partial necrosis of the flap was observed in 1 of 16 cases (6%). For vaginal reconstruction, the surrounding myocutaneous flap or perforator flap can be selected depending on the depth and extent of the defect. Donors can be closed by using combined flaps, especially for a wide range of defects. Irradiated bladder-vaginal fistulas may require a bilateral approach from the bladder and vagina. In the future, reconstructive surgery that considers sexual function will be required for GID as well. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Luxanos).

A0981 - Musculocutaneous latissimus dorsi free flap phalloplasty: Animal training model for reconstructive surgeons

A0981 - Musculocutaneous latissimus dorsi free flap phalloplasty: Animal training model for reconstructive surgeons

Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes

Abstract Background: In the decision-making process toward covering various Achilles' tendon region, knowledge about patient related outcomes after surgery and rehabilitation is important. Therefore, we aimed to present an overview of outcomes and select the most appropriate flaps used for covering soft tissue defects over Achilles' tendon region. Aim of Study: Study aimed to analyse and determine the suitable reconstructive surgical options for Achilles' tendon coverage and to evaluate the clinical, functional and aesthetic outcomes. Patients and Methods: Between September 2017 and December 2019, 25 patients with skin loss over Achilles' tendon region were admitted to Menoufia University Hospital and Shebin-Elkom Teaching Hospital. The soft tissue defects ranged from 3x2 to 16x12 cm. Six types of flaps were used for the coverage of concomitant skin defects. Results: There was no complete flap loss and all flaps survived. Lateral supra malleolar flap (28%) was used in seven patients, distally based peroneus brevis muscle flap (16%) in four patients, posterior tibial artery perforator flap (24%) in six patients, peroneal artery perforator flap (4%) in one patient, reversed sural artery flap (24%) in six patients, and free latissimus dorsi musculocutaneous flap (4%) in one patient. Two patients were subjected to debridement and covered with split thickness skin graft (STSG). One patient suffered from chronic ulcer formation which was covered with lateral supra malleolar artery flap. The algorithm of one-stage reconstruction was established, according to the defect size of skin. Conclusion: Perforator flaps, lateral supra malleolar artery flap, and the distally based peroneus brevis muscle flap were a suitable option for coverage of small to intermediate sized defects; reversed sural artery flap is best for coverage of moderate to large size defects and free flaps are the best choices for complex wide reconstructions.

Recycling of flap pedicle in complex lower extremity reconstruction: A proof of free muscle flap neovascularization

This article portrays the authors’ clinical experience of a complex case of lower extremity reconstruction using a recycled pedicle from 10 years old free latissimus dorsi musculocutaneous flap to supply a new free anterolateral thigh flap for proximal tibia wound defect reconstruction. It provides clinical evidence that muscle neovascularization occurs and supports the dogma peripheral tissue neovascularization. This case stipulates that recycling of pedicle is feasible, when used with appropriate strategy and safety and also provides evidence for the long-term survival of greater saphenous vein grafts in lower extremity reconstruction.

Dual Purpose of De-Epithelialized Latissimus Dorsi Musculocutaneous Flap for Treatment of Chronic Frontal Sinusitis and Frontal Bone Defect.

Treating frontal sinusitis refractory to endoscopic sinus surgery and complicating frontal bone defect remains a challenge. One surgical option determined is free flap transfer, which has the versatility to accommodate adequate sinus obliteration and reconstruct skin and bone defects. After successful free flap transfer, forehead recessus deformity can emerge as an esthetic problem for patients waiting for cranioplasty. Hence, the authors examine three cases in which they performed free latissimus dorsi musculocutaneous (LDM) flaps for chronic frontal sinusitis with frontal bone defect. All LDM flaps survived without complications, and all patients achieved passable forehead contours without cranioplasty and with no occurrence of infection. In our procedure, the muscle portion of the LDM flap was used to obliterate the frontal sinus, which is similar to conventional free LDM flap. Conversely, our procedure also uses the de-epithelialized skin paddle of the LDM flap filled with the frontal bone defect, which is distinct from conventional free LDM flap. Thus, preventing postoperative forehead recessus deformity has been the identified as primary advantage of our procedure. The use of the free de-epithelialized LDM flap transfer fulfills two goals: controlling chronic frontal sinusitis and restoring a passable forehead contour.

Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient

Introduction:The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site.Patient concerns:A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist.Diagnosis:Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis.Interventions:The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width.Outcomes:After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh.Conclusion:ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.

Latissimus Dorsi-Myocutaneous Flap in the Repair of Titanium Mesh Exposure and Scalp Defect After Cranioplasty.

Titanium mesh was widely used for cranium defect repair but associated with high complication rates. In this study, the authors describe a method using latissimus dorsi-myocutaneous flap in the repair of titanium mesh exposure and scalp defect after cranioplasty, and the plate retaining is also achieved. Fifteen patients from April 2012 to May 2016 underwent this procedure, the age ranged from 32 to 62 years and 47 years old on average, and all the patient had plate exposure combined with surgical site infection and variation of scalp defect. All the patients had fully flap survive, and follow up ranged from 6 months to 24 months, 1 patient had titanium mesh re-expose and received additional operation to remove the plate. The free latissimus dorsi musculocutaneous flap could supply large size of bulky tissue coverage with good blood supply and strong anti-infection ability. This method was an option for retaining the titanium mesh and repairing the exposure for the mild infection with small size scalp defect patient.

A Case of Using a Flap in Flap after the Free Latissimus Dorsi Musculocutaneous Flap Transfer

A Case of Using a Flap in Flap after the Free Latissimus Dorsi Musculocutaneous Flap Transfer

浅大腿動脈の再建を要した下腿の遊離広背筋皮弁移植の 1 例

浅大腿動脈の再建を要した下腿の遊離広背筋皮弁移植の 1 例

Reconstruction of Complex Hemipelvectomy Defects: A 17-year Single-institutional Experience With Lower Extremity Free and Pedicled Fillet Flaps

PURPOSE: Hemipelvectomy procedures result in massive soft tissue defects.1,2 The standard reconstructive approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps; however, certain oncologic situations can preclude the use of local tissue flaps.3,4 In such cases, a suitable alternative to provide sufficient soft tissue coverage is the use of fillet flaps, which are defined as pedicled or free flaps harvested from amputated parts.5 The purpose of this study is to present our institution’s experience with using both pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS: The authors performed a retrospective chart review of patients who underwent hemipelvectomy followed by fillet flap reconstruction from 2001 to 2018. Patient demographics, clinical and surgical characteristics, postoperative outcomes, and complications were reviewed. RESULTS: Ten patients were identified and included. Mean age was 51 ± SD 12.4 years. Six patients (60%) underwent standard external hemipelvectomy, and 4 patients (40%) extended external hemipelvectomy. Seven (70%) lower extremity fillet flaps were performed as free tissue transfers, and 3 (30%) were pedicled flaps. Mean flap size was 1,153 ± SD 1,137 cm2. Mean follow-up was 5 months (range, 1–24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION: Reconstruction with either pedicled or free lower extremity fillet flaps is a valuable reconstructive modality for managing acquired soft tissue defects following hemipelvectomy. This useful technique mitigates donor site morbidity, while simultaneously delivering adequate soft tissue coverage with an acceptable complication profile. REFERENCES: 1. Senchenkov A, Moran SL, Petty PM, et al. Soft-tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg. 2009;124:144–155. 2. Tashiro K, Arikawa M, Fukunaga Y, et al. Free latissimus dorsi musculocutaneous flap for external hemipelvectomy reconstruction. Microsurgery. 2019;39:138–143. 3. Senchenkov A, Moran SL, Petty PM, et al. Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol. 2008;15:355–363. 4. Houdek MT, Andrews K, Kralovec ME, et al. Functional outcome measures of patients following hemipelvectomy. Prosthet Orthot Int. 2016;40:566–572. 5. Bibbo C, Newman AS, Lackman RD, et al. A simplified approach to reconstruction of hemipelvectomy defects with lower extremity free fillet flaps to minimize ischemia time. J Plast Reconstr Aesthet Surg. 2015;68:1750–1754.

Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery.

Despite a variety of free flaps that have been described for creation of the neophallus in gender affirmation surgery, none present an ideal solution. We evaluated our patients and outcomes after gender affirmation phalloplasty using musculocutaneous latissimus dorsi free flap. Between January 2007 and May 2017, 129 female transsexuals, aged 20-53years (mean 24years) underwent total phalloplasty using latissimus dorsi free flap. Urethral lengthening was performed by combining a vaginal flap, labia minora flaps and a clitoral skin flap. Suitable sized testicular implants are inserted into the new scrotum. Penile prosthesis implantation, additional urethral lengthening and glans reshaping were performed in the following stages. The mean follow-up period was 43months (ranged from 13 to 137months). There were one partial and two total flap necrosis. The average size of the neophallus was 14.6cm in length and 12.4cm in girth. Total length of the reconstructed urethra during the first stage ranged from 13.4 to 21.7cm (mean 15.8cm), reaching the proximal third or the midshaft of the neophallus in 91% of cases. Satisfactory voiding in standing position was confirmed in all patients. Six urethral fistulas and two strictures were observed and repaired by minor revision. Malleable and inflatable prostheses were implanted in 39 and 22 patients, respectively. Musculocutaneous latissimus dorsi flap is a good choice for phalloplasty in gender affirmation surgery. It provides an adequate amount of tissue with sufficient blood supply for safe urethral reconstruction and penile prosthesis implantation.

Radiation Induced Perineo-Coccygeal Defect Coverage with Latissimus Dorsi Musculocutaneous Free Flap

Radiation Induced Perineo-Coccygeal Defect Coverage with Latissimus Dorsi Musculocutaneous Free Flap