Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity. Issue 10 (7th September 2022)

• Record Type: Journal Article
• Authors: He, Jiqiang; Qing, Liming; Wu, Panfeng; Ketheeswaran, Suvetha; Yu, Fang; Tang, Juyu
• Is Part Of: Orthopaedic surgery. Volume 14:Issue 10(2022)
• Page Start: 2598
• Page End: 2606
• Publication Date: 2022-09-07
• Subjects: extended latissimus dorsi musculocutaneous (LD) flap -- extremity -- free tissue flaps -- large soft tissue defects -- microsurgery; Orthopedic surgery -- Periodicals; Orthopedics -- Periodicals; Musculoskeletal system -- Wounds and injuries -- Periodicals; 617.47005
• DOI: 10.1111/os.13454
• Languages: English
• ISSNs: 1757-7853

Abstract

Abstract : Objective: The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities. Methods: From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm × 10 cm to 37 cm × 21 cm. Forty‐one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty‐eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single‐ and double‐wing extended LD flaps were designed and harvested according to the shape of the wounds. Results: The flaps received consisted of 64 single‐wing and eight double‐wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re‐exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow‐up was 15.7 months (range, 10–56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow‐up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion: Single‐ and double‐wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results. Abstract : This study introduces our experience designing different extended LD flaps for large wounds in the extremities. This article demonstrated that the extended LD flap has adequate volume, limited donor site morbidity (donor site can be closed directly), short operative time, and less surgical complexity, making it a reliable method for large skin and soft tissue defects in the extremity. We believe that our study makes a significant contribution to the literature because this is a new LD flap design and classification system with the aforementioned advantages of using this technique vs the conventional method. In addition, this article will represent the largest case series in the literature.