Microvascular Flap Reconstruction Research Articles

The use of tumor-to-tongue thickness ratio to predict the need for microvascular flap reconstruction following glossectomy in carcinoma tongue

Background: Microvascular flap reconstruction (MFR) of medium–large tongue defects following ablative surgery is the standard of care. The decision for MFR is often made prior to surgery or intraoperatively depending on the extent of the defect and the volume of remnant tongue. However, there exists no objective technique to predict this requirement preoperatively. This knowledge is crucial for counseling and planning. We aimed to identify an objective magnetic resonance imaging (MRI) measurement tool to predict the need for MFR of tongue tumors. Materials and Methods: This was a retrospective analysis of patients undergoing surgery (with or without reconstruction) for squamous cell carcinoma of the tongue. Patients had a preoperative MRI as part of their assessment. As per our institution protocol, the decision for the requirement of MFR was made by a consensus of two experienced reconstructive surgeons intraoperatively. This decision was correlated with the ratio of tumor volume to the total tongue volume (tv) as observed in the MRI. Results: A total of 47 patients were identified. Twenty-eight patients underwent reconstruction, while 19 did not. The ratio of tumor thickness to tongue thickness (Tt/tt) was calculated, and a cutoff of >0.395 (sensitivity 89.3% and specificity 89.5%) was found to significantly correlate with the decision for MFR (P 4.2 (sensitivity 83.3 and specificity 90) was found to be correlated significantly with the decision for MFR (P

Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study.

Microvascular reconstruction is the standard of care in head and neck reconstruction, though its perioperative safety in an older population has been controversial due to safety concerns, warranting further investigation. An "older" (≥71 years) cohort undergoing reconstruction after mandibulectomy/glossectomy was compared to the remaining population in a National Surgical Quality Improvement Program (2008-2016) analysis. Cases required both a mandibulectomy/glossectomy and microvascular or local flap reconstruction (exclusion criteria: missing ages and simultaneous microvascular and local flap reconstruction). Demographics, comorbidities, and procedure types were analyzed on 985 patients (236 [24.4%] were ≥71). Outcomes were compared by reconstruction type. Regressions were performed calculating the impact of age on length of hospital stay (LOHS) and operative time. Ablative procedures were comparable, but older patients received local flaps at higher rates (22.5% vs. 9.6%; p < .001). The older population had more comorbidities (higher ASA class [p < .001], diabetes [p < .001], and hypertension [p < .001]). After Bonferroni correction, univariate subgroup analyses of soft tissue and bone/composite microvascular flaps revealed similar outcomes (except increased medical complications in the older cohort undergoing a bone free flap [p = .002]). Controlling for a variety of factors, older age resulted in longer LOHS (B: 1.4 days; 95% CI: 0.1-2.8 days; p = .035), but not operative time (B: -21.90 min; 95% CI: -52.76 to 8.96 min; p = .164). While increased age (≥70 years) was associated with a longer LOHS, complication rates were comparable. Although limited by the retrospective nature, evidence supports microvascular reconstruction in the elderly population with comparable outcomes.

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat?

BackgroundTemporary tracheotomies are often used in oral microvascular flap reconstruction surgery to secure postoperative airway management and avoid emergency tracheotomies. Even when planned electively, a tracheotomy can cause severe and life-threatening complications. The aim of this study was to evaluate the complications of tracheotomies performed on oral cancer patients with microvascular flap reconstructions and differentiated patterns, which could lead to postoperative complications. Methods150 patients, treated in the Department of Oral and Maxillofacial Surgery from March 2017 to August 2018, were included in this study. Patient records and perioperative data were analysed and the following specific items were evaluated: time after surgery until removal of the tracheal cannula, complications, cause and point of time of reinsertion of the cannula, anticoagulative treatment, ASA grade (American Society of Anaesthesiologists), TNM stage, and patient-specific data. Results30 patients (20%) developed tracheotomy-associated complications, most commonly pneumonia (50%). There was a significant correlation between the time period until removal of the cannula and the occurrence of complications such as pneumonia and bleeding. ConclusionThe results of our study lead us to recommend continuing to perform temporary tracheotomies in oral cancer surgery with microvascular flap reconstruction. The overall complication rate is low and postoperative airway management can be performed in a safe and controlled manner. Nevertheless, the time period for the inserted cannula should be kept as short as possible.

Precision of Simultaneous Guided Dental Implantation in Microvascular Fibular Flap Reconstructions With and Without Additional Guiding Splints

Dental rehabilitation in patients receiving free flap reconstructive surgery on the mandible or maxilla is an important part of bringing patients back to normality in both a physical and psychological way. It is therefore important to be able to do this in the fastest way possible. Virtual preplanned reconstructions of jaws with implants placed simultaneously are a good way to expedite this process and have the advantage of allowing true backward planning to achieve bone placement where it prosthetically needs to be. Thus, the precise transfer of the virtually preplanned implant position to the intraoperative situation is crucial for prosthetic rehabilitation. We compared a control group of patients (4 patients with 15 implants) with preplanned fibular reconstructions of the mandible with implants incorporated in the planning and a trial group of patients (4 patients with 13 implants) with an additional intraoperative splint for the verification of the implants' angulation. The preoperative planning and postoperative computed tomography scans were compared. The average positioning error at bone level was 0.9mm in the trial group and 1.3mm in the control group. The average angulation error in the buccolingual plane was 2.9° in the trial group and 5.5° in the control group; axially, the difference was 6.3° in the trial group and 4.1° in the control group. The use of digitally backward-planned fibula cutting guides with direct dental implant positioning is feasible, and the precision found is comparable with that of standard splint-guided implant placement in the general population. Although the axial angulation error has more to do with anatomic variance and positioning of the bony cutting guide, the trial population clearly profited from the additional splint in the important buccolingual angulation. Overall, we showed a high level of precision over all implants in both groups.

Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans.

We aimed to compare the clinical outcomes between endovascular treatment and inframalleolar bypass surgery for critical limb ischemia (CLI) in patients with thromboangiitis obliterans (TAO) and to assess the role of bypass surgery in the era of innovative endovascular treatment. Between January 2007 and December 2017, a total of 33 consecutive patients with the diagnosis of TAO presenting with CLI who underwent endovascular treatment (endovascular group, n = 22) or bypass surgery to the pedal or plantar vessels (bypass group, n = 11) were included and analyzed retrospectively. The primary endpoint was defined as a major amputation of the index limb, and the secondary endpoint was defined as graft occlusion, regardless of the number of subsequent procedures. In the bypass group, six patients (55%) had undergone previous failed endovascular procedures and/or arterial bypass surgery to the index limb before inframalleolar bypass, and two patients (18%) received microvascular flap reconstruction after bypass surgery. During the median follow-up period of 32 months (range 1–115 months), there were no significant differences in primary and secondary endpoints between the two groups although the bypass group had a higher Rutherford class than the endovascular group. Kaplan–Meier survival analysis showed that there were similar limb salvage (P = 0.95) and graft patency rates (P = 0.39). In conclusion, endovascular treatment is a valid strategy leading to an acceptable limb salvage rate for TAO patients, and surgical bypass to distal target vessels could play a vital role in cases of previous failed endovascular treatment or extensive soft tissue loss of the foot.

Mycobacterium Ulcerans soft tissue defects: reconstructive challenges

Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series. A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy. Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes. This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.

Current practice trends in microvascular free flap reconstruction by fellowship-trained otolaryngologists

PurposeIn the field of head and neck microvascular surgery, there are currently no clear, universally accepted recommendations on the intraoperative, preoperative, and postoperative management of these patients. Materials and methodsA 23-question cross-sectional survey was distributed to otolaryngologists who perform microvascular reconstruction. Information about practice setting, fellowship training background, intraoperative practice, postoperative practice, and surgical complications were analyzed. ResultsComplete survey responses were received from 102 (32.8% response rate) of surveyed otolaryngologists who perform microvascular surgery. A great degree of variability was noted in intraoperative and postoperative care of free flap patients. Overall, self-reported free flap survival-rates were relatively high, despite the variability in practice, with the majority of surgeons (74%) reporting flap survival rate of 96–100%. Complication rates requiring return to the operating room were low; all respondents reported <20% overall complications with <10% re-operation rates due to vascular complications. ConclusionAn increasing number of microvascular-trained otolaryngologists are performing free flaps. Self-reported free flap survival rates are high and complication rates are low, despite significant variability in intraoperative and postoperative practices among otolaryngologists performing microvascular flap reconstruction. By identifying these differences among surgeons, we hope to provide the impetus for further academic dialog and prospective trials.

Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation

For organ transplant recipients, cancer secondary to immunosuppressive therapy threatens long-term survival. The associated multiple comorbidities make major free flap reconstruction following cancer surgery a complicated event. This study evaluates the outcomes of free flap reconstruction in this population. A retrospective chart review of all head and neck free flap cases in patients with a history of organ transplantation receiving systemic immunosuppressive therapy between 2005 and 2017 at a single-institution was conducted. Of 57 organ transplant patients, 25 patients (28 flaps) were included. Flaps used included the anterolateral thigh (n = 17), radial forearm (n = 4), latissimus dorsi (n = 3), fibula (n = 2), lateral arm (n = 1), and thoracodorsal artery perforator (n = 1) flaps. The most common organ transplant was kidney, then lung, liver, and heart. Mean inpatient stay was 8.2 days (range, 4-28). Complications occurred in 15 patients, with no total or partial flap losses. Major head and neck free flap reconstructive surgery can be performed safely in organ transplant patients receiving immunosuppressive therapy. Meticulous multidisciplinary care is required to achieve consistently successful outcomes.

ACSNSQIP Risk Calculator in Indian Patients Undergoing Surgery for Head and Neck Cancers: Is It Valid?

Pre-operative assessment is vital to determine patient-specific risks and minimize them in order to optimize surgical outcomes. The American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) Surgical Risk Calculator is the most comprehensive surgical risk assessment tool available. We performed this study to determine the validity of ACSNSQIP calculator when used to predict surgical complications in a cohort of patients with head and neck cancer treated in an Indian tertiary care center. Retrospective data was collected for 150 patients with head and neck cancer who were operated in the Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, in the year 2016. The predicted outcome data was compared with actual documented outcome data for the variables mentioned. Brier's score was used to estimate the predictive value of the risk assessment generated. Pearson's r coefficient was utilized to validate the prediction of length of hospital stay. Brier's score for the entire calculator was 0.32 (not significant). Additionally, when the score was determined for individual parameters (surgical site infection, pneumonia, etc.), none were significant. Pearson's r value for length of stay was also not significant (p = .632). The ACSNSQIP risk assessment tool did not accurately reflect surgical outcomes in our cohort of Indian patients. Although it is the most comprehensive tool available at present, modifications that may improve accuracy are allowing for input of multiple procedure codes, risk stratifying for previous radiation or surgery, and better risk assessment for microvascular flap reconstruction.

The Cardiovascular monitoring and Vasopressor use in Head & Neck microvascular flap reconstruction.

The Cardiovascular monitoring and Vasopressor use in Head & Neck microvascular flap reconstruction.

Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification and outcomes assessment

BackgroundTo determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. MethodsA series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. ResultsTwenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC. ConclusionsCardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.

Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care

We aimed to identify and evaluate the clinical challenges involved in microvascular flap reconstructions of defects caused by resection of head and neck cancer among patients aged 85 and over. We designed a retrospective study of patients who were treated in the head and neck department of a tertiary referral centre from 2005 to 2015, and all patients aged 85 years and over who had reconstructions with microvascular flaps for head and neck cancer were entered into the study. A total of 24 patients fulfilled the criteria, of whom 15 were men and nine were women. The median (range) duration of stay in hospital was 23 (14-59) days. Eighteen patients had an American Society of Anesthesiologists (ASA) score grade II and six patients grade III. The median (range) operating time was 420 (310-705)minutes, and operative blood loss 550 (200-1500)ml. Sixteen patients had prophylactic tracheostomies, nine of whom developed postoperative surgical complications, seven associated with the tracheostomy (p=0.005). Resections of head and neck cancer and microvascular reconstructions in patients aged 85 and over are associated with a high incidence of postoperative complications. Medical complications tend to be associated with the tracheostomy while surgical complications are potentially associated with the ASA score. Although the morbidity is high, complex resections and microvascular reconstructions are successful with optimum recovery, and age did not seem to influence the outcome. However, it is necessary to avoid prophylactic tracheostomy if possible in these patients.

Reply: Perioperative Tamoxifen Use and Risk of Deep Vein Thrombosis: Role of Caprini Risk Assessment Model Should not be Discarded: Is It Necessary to Stop Tamoxifen Therapy in Microvascular Flap Reconstruction?

Reply: Perioperative Tamoxifen Use and Risk of Deep Vein Thrombosis: Role of Caprini Risk Assessment Model Should not be Discarded: Is It Necessary to Stop Tamoxifen Therapy in Microvascular Flap Reconstruction?

Outcome of heavily pretreated recurrent oral squamous cell carcinoma after salvage resection: A monocentric retrospective analysis.

The goals of the present study were to analyze survival data of patients who received salvage surgery due to recurrent oral squamous cell carcinoma (OSCC) of the oral cavity with curative intent, and to investigate the feasibility of microvascular flap reconstruction in a heavily pretreated patient cohort. A total of 32 patients who received salvage surgery due to recurrent OSCC were included. The cohort was analyzed in regard to relevant clinical and pathological features. Survival was estimated by using Kaplan-Meier analysis and verified in a multivariate Cox regression model. All patients recovered well from surgery. The most common severe complication was free flap failure in 7 patients (24.1%). R0-resection was achieved in 16 patients (50%). Univariate Kaplan-Meier analysis showed that the estimated overall survival and disease-free survival of all patients after 24 months were 37.8% and 30.9%, respectively. Multivariate testing identified R1-resection was the only independent predictor of treatment failure. Salvage surgery is the only potential curative treatment option in recurrent OSCC. Microvascular reconstruction is feasible in heavily pretreated patients, but it is associated with a higher free flap failure rate. Recurrent OSCC in heavily pretreated patients shows different biological behavior. Further prospective clinical and molecular studies are needed to develop a better molecular understanding of recurrent OSCC and the best and safest individual therapeutic strategy.

Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes

Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications. Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D health-related quality of life (HRQoL) instrument were applied. Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8cm (SD: 2.5). Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population. Segmental tibia transport and lengthening to correct limb length discrepancy do not compromise the microvascular muscle flap. Combined microvascular LD flap reconstruction and the Ilizarov technique can be used in treating acute compound tibial defects, pseudoarthrosis, and osteitis, all associated with significant amputation risk. Fair long-term functional outcomes and HRQoL are achieved when these combined techniques are used.

Impact of microvascular free flap reconstruction in oral cavity cancer: our experience in 130 cases.

SUMMARYThe aim of this study was to investigate the oncological outcomes in patients affected by oral carcinoma treated with radical compartmental surgery followed by microvascular flap reconstruction. We conducted a retrospective analysis on a cohort of 130 patients. All patients underwent ablative tumour resection (compartmental surgery) followed by immediate reconstruction with free flaps and adjuvant chemoradiotherapy, when necessary according to our tumour board and international guidelines. Disease-specific survival (DSS) curves were obtained using the Kaplan-Meier method. Log-rank test and generalised Wilcoxon test were used to investigate the most important prognostic factors on 5-year DSS. A Cox proportional hazards model was constructed to provide hazard ratios or relative risks for individual variables. 88.5% of patients were affected by SCC. There were 46 (35.4%) women and 84 (64.6%) men in the sample with a mean age of 58.5 years. At the end of the follow-up period, 36 (27.7%) patients died, only 3 of which for other causes. The 5-year DSS rate was 67.8% (S.E. 4.9%). In univariate Kaplan-Meier analysis and in multivariate Cox regression model, seven variables were found to have a significant relationship with DSS: T (p = 0.026) and N (p = 0.0001) status, clinical stage (according to the UICC TNM Sixth Edition) (p = 0.007), margins of resection (p = 0.001), extracapsular spread (p = 0.005), recurrence of disease (p = 0.00002) and treatment modality (evaluated as surgery alone or surgery + RT/CHT) (p = 0.004). Our results confirmed findings already reported in the literature, and allowed us to conclude that compartmental surgery combined with free flap reconstruction can increase survival in oral cancer patients.

Recurrent abdominal wall dermatofibrosarcoma protuberans in a child: a challenging reconstruction.

IntroductionDermatofibrosarcoma protuberans is an uncommon low-grade soft tissue sarcoma with a high potential for recurrence as it has irregular finger like extensions.Case descriptionWe report a case of a large, recurrent dermatofibrosarcoma protuberans in a child involving the anterior abdominal wall, which posed a challenge for reconstruction. Peritoneum sparing full thickness resection of the anterior abdominal wall, meshplasty and a free anterolateral thigh flap was performed for reconstruction of the defect.Discussion and evaluationLarge composite defect, involving more than half of the anterior abdominal wall, necessitate a free flap reconstruction. Although these reconstructions are technically challenging in children, they are the only option available.ConclusionComplete surgical excision is essential for DFSP of the abdominal wall, which may result in large challenging defects. Free flaps remain the only option in this scenario and hence it is essential to have expertise for microvascular flap reconstruction.

Surgical management of osteoradionecrosis of the jaws.

The objective of this study is to evaluate our 10-year clinical experience in surgical management of patients with osteoradionecrosis (ORN) unresolved with conservative nonoperative treatment. The medical records of 120 patients who had been surgically treated for ORN during a 10-year period (January 2003 to January 2013) were retrospectively reviewed. The most predilection ORN site was mandible (82.5%), followed by the maxilla (11.7%). ORN developed within initial 12 months in 39.2% and within the first 3 years in 68.3%. The median radiation dose was 68.1 Gy (range, 35-148 Gy), but 51 patients (42.5%) experienced ORN even though radiation doses were controlled under 60 Gy. Surgical trauma, as we believed, was the most important factor leading to this result. Among all the patients, 12 (10.0%) patients were found ineligible for operative treatment due to comorbid systematic diseases whereas none healed or improved. In terms of surgical management of the rest of the 108 patients, 90 (75.0%) patients underwent radical resection (4 patients unhealed), and 18 (15.0%) patients underwent mild surgical procedures such as sequestrectomy or debridement (1 patient unhealed). Of the 90 radical resection patients, 58 patients underwent radical resections and immediate microvascular flap reconstruction (19 bone flaps and 39 soft flaps), and 32 patients only experience radical resection (5 patients received second-stage reconstruction). According to follow-up information, 55 patients were free of disease. Though priority should be given to surgical treatment for the patient whose ORN does not respond to conservative nonoperative treatment, we may as well take into account more individualized regimens based on ORN severity. A hard lesson learned from our article is that the oral maxillofacial surgeon should minimize the trauma for jaws as possible as he can, especially to patients who need to receive postoperative radiotherapy.

Intraoperative Management of Free Flaps

Intraoperative management of hemodynamic instability during microvascular flap reconstruction is often based on anecdotal experience. Randomized controlled trials are difficult to perform when overall success rates are high. This study seeks to determine current practices for management of intraoperative hypotension during microsurgical free tissue transfer. An anonymous, 17-question, multiple choice, and open response online survey was distributed to university surgeons identified from the American Society of Plastic Surgeons and American Society of Reconstructive Microsurgeons online membership listing. Responses were collected from April 1, 2012, to May 1, 2012. Questions included number of years of microsurgery experience, number of flaps performed yearly, acceptable lower limits of blood pressure, preferences for treatment of hypotension, intraoperative conditions (hemodilution, temperature, and regional anesthesia), preferred methods of postoperative flap monitoring, and timing/method of prophylaxis of thromboembolic complications. Anonymous responses were analyzed individually as well as per respondent's experience. The response rate was 26.7% (145/544), with 88.3% performing microsurgery. Sixty-two percent performed 24 or less free flaps per year (low volume). Thirty-seven percent performed greater than 24 per year (high volume). The acceptable lower limit (SD) of systolic blood pressure was 92.6 (11.3) mm Hg for the low-volume group and 86.9 (16.2) for the high volume group (P = 0.035). The treatment of choice for hypotension was fluid administration (94.5%). Vasopressors were used by 50.0% of low-volume respondents and 38.1% of high-volume respondents (P = 0.312). Twenty-two respondents (23.2%) stated they had a flap loss due to administration of vasopressors. There was no significant difference between high- and low-volume surgeons' responses. A national survey of microsurgeons demonstrates that many would not use vasopressors to treat intraoperative hypotension regardless of their experience. Although subject to responder bias, this report, nevertheless, outlines current practice. The need to develop a scientific basis for these practices is evident.

Pedicled latissimus dorsi flap for arm defects: A report of twenty-three cases

Background: The latissimusdorsi muscle or myocutaneous flap is one of the most reliable and versatile flaps used in reconstructive surgery. It is known for its use in chest wall and post mastectomy reconstruction and has also been used effectively for coverage of large soft tissue defects in the head and neck and upper limb either as a pedicled flap or as a free flap. It has been described for reconstruction of hand and foot defects as microvascular flap and functional reconstruction of elbow in brachial plexus injuries. Aim: Evaluate its role in reconstruction of arm defects. Patient and Methods: Twenty three cases of pedicled Latissimus dorsi flaps for arm defects are enrolled into the study. The cause of the defect, the site and size of the defect, associated injuries and timing of flap cover are also noted. Observaion and Result: Out of 23 cases majority of defects are from trauma (19 cases) and rest from neoplastic resection (4 cases) all belonging to the age group of 15-45 years with defect size ranging from 10 × 15 cm 2 to 15 × 25 cm 2 . The average duration of follow up was 6 months to 1 year. All the flaps survived without partial loss. Six patients developed seroma at flap donor site which settled with multiple aspirations. Two patient developed hyper trophy at the borders at the donor site scar. Three patients had stretching of the scar. There were no other donor site complications at the flap or skin graft sites. All patients have cosmetically satisfactory result. Conclusion: Pedicled Latissimus dorsi muscle and musculocutaneous flap with a split thickness skin graft is the primary choice for reconstruction of large complex arm defects.