Transfer Of Latissimus Dorsi Myocutaneous Flap Research Articles

Dynamic Reconstruction Using Accessory-innervated Pedicled Latissimus Dorsi Flap for Upper Trapezius Muscle Defect.

The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial movement. We encountered a case in which the upper trapezius muscle was completely resected due to myxofibrosarcoma that occurred in the upper part of the left trapezius muscle, and reconstruction was performed using a pedicled latissimus dorsi flap with the accessory nerve transferred, resulting in favorable motor function. A 74-year-old woman developed myxofibrosarcoma in her left neck 1 year and 4 months ago, and underwent two surgical excisions at a nearby hospital. However, two months prior, she relapsed again, and was referred to our hospital, where she underwent submandibular lymph node dissection, wide tumor resection, and reconstruction using a latissimus dorsi flap. For latissimus dorsi myocutaneous flap transfer, the stump of the thoracodorsal nerve and accessory nerve were anastomosed to facilitate nerve transfer. Four months after surgery, she was able to raise her shoulder, and surface electromyography showed potentials comparable to her unaffected side. The innervated latissimus dorsi myocutaneous flap is frequently used for dynamic reconstruction of facial, brachialis, rectus abdominis, and deltoid muscles, but this is the first case report describing its use for dynamic reconstruction of the trapezius muscle.

Free anterolateral thigh myocutaneous flap combined with pedicled latissimus dorsi myocutaneous flap transfer for functional reconstruction after resection of huge shoulder tumor

Objective: To investigate the method and effect of free anterolateral thigh myocutaneous flap combined with pedicled latissimus dorsi myocutaneous flap transfer for functional reconstruction after resection of huge shoulder tumor. Methods: The clinical data of 6 patients who were treated with pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap to repair large-area complex defects after shoulder tumor resection at Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital from December 2015 to December 2020 were retrospectively analyzed. There were 2 males and 4 females, with an average age of 41.7 years (range:29 to 56 years). There were 2 cases of synovial sarcoma,2 cases of phylloid cell sarcoma,1 case of liposarcoma and 1 case of fibrosarcoma. Before this operation, tumor resection had been performed for 1 to 5 times on each case,and the course of disease was 6 to 24 months. Pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap were used to repair soft tissue defects and reconstruct deltoid function. Postoperative flap status, complications, appearance and function of upper limbs and tumor recurrence were recorded. Results: Six patients were followed up for an average of 21.6 months (range: 12 to 36 months). There were no serious complications after operation,and all flaps survived. No tumor recurrence was found. The appearance of shoulder contour reconstructed by flaps was satisfactory. The reinnervation effect of lateral femoral muscle was confirmed recovered smoothly by neuroelectromyography 3 months after operation. Shoulder function was mildly limited in 3 patients,moderately limited in 2 patients and severely limited in 1 patient. All patients reported significant improvement in shoulder discomfort.The overall functional results of all patients were satisfactory. Conclusion: Combined myocutaneous flaps transplantation can perfectly repair the wound left after the resection of huge shoulder tumor,minimize the recurrence of tumor,reconstruct the function of shoulder joint and greatly improve the quality of life of patients.

Jumping Extracorporeal Free Latissimus Dorsi Myocutaneous Flap for Aesthetic Reconstruction After Anterior Skull Base and Orbital Cancer Resection.

The authors introduce successful free latissimus dorsi myocutaneous flap transfer, which was temporarily placed onto the face extracorporeally because the position of orbital defect is far from the submandibular microvascular anastomosis region. The authors then secondarily resected the excess part of the flap after 3 weeks of neovascularization period. Although multistage surgery is needed, jumping extracorporeal flap is a useful option to achieve aesthetic outcomes especially in a challenging situation.

Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review

Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.

Role of Early Physiotherapy to Enhance Functional Ability in a Patient with Bipolar Latissimus Dorsi Myocutaneous Flap Transfer at the Elbow: A Case Report

Role of Early Physiotherapy to Enhance Functional Ability in a Patient with Bipolar Latissimus Dorsi Myocutaneous Flap Transfer at the Elbow: A Case Report

Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer

To investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer. Between January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly. All the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites. The latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.

Restoration of elbow function with pedicled latissimus dorsi myocutaneous flap transfer

Restoration of elbow function is a challenge for orthopaedic surgeons, and many procedures have been described. This study reviewed 17 patients who underwent latissimus dorsi myocutaneous flap transfer for functional reconstruction of elbow flexion or extension. Of the 10 patients who underwent reconstruction for elbow flexion, grade 4 strength of elbow flexion by manual muscle testing was obtained in 8 and grade 3 was obtained in 2. Mean postoperative active elbow flexion was 111 degrees . Of the 7 patients who underwent reconstruction for elbow extension, grade 4 strength of elbow extension was obtained in 3, grade 3 was obtained in 3, and grade 2 was obtained in 1. The 3 patients showing unsatisfactory restoration of flexion or extension strength had associated preoperative weakness of the latissimus dorsi muscle. Preoperative assessment of the latissimus dorsi muscle was most important for obtaining satisfactory results, because preoperative muscle strength influenced the postoperative functional outcome.

上腕切断の治療経験 広背筋移行による機能再建

Two patients with a transhumeral limb amputation had their limb replanted. In both patients latissimus dorsi myocutaneous flap transfer was performed for reconstruction of unrecovered limb function.Case 1: A 11-year-old boy suffered an avulsion-type amputation of his left upper arm in a traffic accident. One and half years after replantation he achieved useful elbow function and active extension of his wrist and digits but did not recover the function of extrinsic finger flexors. Latissimus dorsi transfer was performed for reconstruction of flexion of digits. Postoperatively he regained powerful hook grip and key pinch.Case 2: A 59-year-old workwoman suffered incomplete amputation of her left upper arm. She lost the elbow flexors and extensors. Latissimus dorsi transfer was performed for elbow flexion. Postoperatively she had 130° of active elbow flexion and lacked 35° of extension.

Latissimus dorsi myocutaneous flap transfer to restore elbow flexion and arm contour

Latissimus dorsi myocutaneous flap transfer to restore elbow flexion and arm contour

Closure of thoracic and lumbar dysgraphic defects using bilateral latissimus dorsi myocutaneous flap transfer with extended gluteal fasciocutaneous flaps.

The latissimus dorsi-gluteal myofasciocutaneous flap has been successfully employed in closure of 6 large thoracolumbar myelomeningoceles in newborn infants. Good wound healing was attained in all cases. The technique of flap mobilization and closure is outlined and possible pitfalls are explained.

The Value of Angiography Prior to Use of the Latissimus Dorsi Myocutaneous Flap

In 5 patients studied, preoperative angiography showed the thoracodorsal artery to be patent in two--both of them then had successful transfers of latissimus dorsi myocutaneous flaps. Obliteration of this artery was apparent in 3 patients, precluding the operation. We suggest that selective preoperative angiography be performed in all patients in whom a latissimus dorsi myocutaneous flap transfer is being considered, as a patent thoracodorsal artery is essential to the success of this procedure.