Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap

The combined loss of the Achilles tendon and the overlying soft tissue in the young ambulant patient with expectations of a normal life is a challenging problem. These patients need not only soft tissue but also dynamic and functional reconstruction. Four cases of major defects of the Achilles tendon and overlying soft tissue after trauma are presented. In each case, the tendon and the overlying soft tissues were reconstructed using only a latissimus dorsi muscle free flap and overlying split-thickness skin graft. In conventional methods, evolved in the reconstruction of the Achilles tendon and soft tissue, the size of the defect was a limit. However, this technique can be used to reconstruct an extensive defect, including distal calf muscle to the plantar metatarsal area. In one case, the flap was harvested in a myocutaneous unit, and the skin portion was deepithelialized for the coverage and enough padding on the bony exposure area in reverse position. The purpose of the present study was to reevaluate the potential of denervated muscle flap for a force-bearing conduit as an alternative reconstructive method of the Achilles tendon. The denervated latissimus dorsi muscle in this study eventually experienced the process of atrophy and fibrosis but maintained its original length. Although there remained some atrophic muscle fibers, a fibrosis of the muscle fibers formed a tendon-like fibrous band, and so the action of the posterior calf muscle could be transmitted through the tendon-like fibrotic change of the denervated latissimus dorsi muscle. The advantages of this technique are that (1) it is a single procedure, (2) it is adaptable to a wide range of defect sizes, (3) it allows faster wound healing supported by well-vascularized tissues, (4) it produces satisfactory function of the ankle joint and a padding effect, and (5) it produces good contour of the posterior calf to the sole and an acceptable donor-site morbidity.     

Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs

Flow-through thin latissimus dorsi perforator flaps were used in six cases with complicated defects of the legs. This flap has a small amount of latissimus dorsi muscle with a considerable amount of fatty tissue removed to make a thin flap. In addition, the flap has several branches of the subscapular vessel, which are interposed to the recipient vessels of the legs. The advantages of this thin flap are: (1) flow-through vascular reconstruction can preserve the main vessels of the damaged legs; (2) the double arterial inflows and venous drainage systems of the flap ensure safe vascularization of the flap; (3) a flow-through venous drainage system from the distal extremities can also be established to prevent congestion of the affected legs; (4) this flap is versatile (it can be either thin or large); and (5) even in emergent ischemic legs, simultaneous elevation of the flap is possible with preparation of the legs. This flow-through flap is indicated for: (1) cases with a large skin defect and obstruction of the main vessels in the leg; (2) cases with a possibility of tumor recurrence in the legs; and (3) young women or girls with a large defect in the legs, rather than the rectus abdominis musculocutaneous flap.     

Bilateral latissimus dorsi V-Y musculocutaneous flap for closure of a large meningomyelocele

Reconstruction of a large meningomyelocele defect with bilateral latissimus dorsi V-Y musculocutaneous flaps is reported. This procedure provides a reliable, well-vascularized soft-tissue coverage over the neural repair with minimum donor-site morbidity.     

Free latissimus dorsi muscle flap with skin graft for treatment of traumatic chronic bony wounds

Based on this review of 35 cases of chronic bony wounds, it would appear that the free-muscle flap method of wound closure and nourishment after thorough dead bone debridement is an attractive and successful alternative to local skin flaps, staged skin flaps, or extend skin-muscle flaps in areas where reliable muscle flaps are not available. It would also seem that the latissimus dorsi muscle flap with skin graft is an ideal donor-muscle transfer with features allowing a favorable and contoured surface in the recipient site and minimal aesthetic and functional deformity in the donor site.     

The free latissimus dorsi flap revisited: a primary option for coverage of wide recurrent lumbosacral defects

In comparison with other regions of the trunk, defects located in the lumbosacral region are infrequent. However, these particular lesions sometimes present difficulties in reconstruction, arising from the quality of the surrounding tissue and the width of the defects. In this area, the skin adheres strongly to subcutaneous tissue and is difficult to mobilize. Attempts to perform local or regional flaps for covering defects of this area often end in necrosis of the flaps, with subsequent risk of infection and unstable wounds. The consequence is larger defects and the need for a wide, tension-free coverage, which can be performed after a wide debridement. The authors report on 10 patients presenting with wide, recurrent (and in some cases, infected) defects of the lumbosacral region, after already having undergone several reconstructive local or regional operations. In all cases, the authors harvested a free latissimus dorsi flap, lengthening the pedicle by means of an arteriovenous suralis loop connected to the thoracodorsal vessels (lumbar defect) or the femoral vessels (sacral defect). The procedure, already described in the past by others, has been revisited by the authors' group and used as the technique of choice in selected cases, that is, in the presence of wide, recurrent, and infected lesions; radiation; and scarring injuries. The authors thus obtained stable coverage with well-vascularized tissue and were able to save the patients any further operations. The authors suggest, therefore, that this procedure can be used in cases of wide and recurrent defects where other conventional procedures have failed. Advantages, disadvantages, and technical features of the method used are discussed in this article.     

The reverse latissimus dorsi muscle flap for closure of meningomyelocele

Closure of the meningomyelocele wound requires stable coverage of the dural repair. In the case presented, multiple conventional attempts at reconstruction failed. A modification of the "reverse" latissimus dorsi flap is presented that successfully managed this low lumbar defect.     

Staged transfer of a free microvascular latissimus dorsi myocutaneous flap using saphenous vein grafts

The use of long vein grafts in the axilla adds a new dimension to the versatility of the latissimus dorsi myocutaneous flap. When suitable recipient vessels are not available for a microvascular anastomosis, long vein grafts can be used in the axilla to double the arc of rotation of the flap, allowing it to cover the buttocks, lower torso, and scalp (Fig. 8). A case is presented in which the latissimus dorsi myocutaneous flap was transferred in stages to cover a large radiation ulcer of the right buttock.     

Management and prevention of lumbar herniation following a latissimus dorsi flap

Lumbar herniation is a rare complication of flank surgery. We present a case of lumbar herniation that followed the mobilization of a latissimus dorsi flap for breast reconstruction. This is an unusual complication, which, to our knowledge, has only been presented twice in the literature. The roles of computed tomography for diagnosis and synthetic mesh for repair are discussed. The anatomy of the lumbar region is reviewed, and preventative measures are discussed.     

More experience with the "reverse" latissimus dorsi musculocutaneous flap: precise location of blood supply

Our work demonstrates that the "reverse" latissimus dorsi musculocutaneous flap has a predictable and consistent blood supply. A major portion of the muscle can be nourished by the dorsal perforating branches of the ninth, tenth, and eleventh intercostal vessels. The skin island based on the "reverse" latissimus dorsi muscle can be as large as 8 X 20 cm. This is confirmed by anatomic dissections and clinical cases. Knowledge of the blood supply facilitates elevation of the flap and extends its utility.     

背阔肌肌皮瓣修复肩背部软组织肉瘤术后缺损研究

目的:分析背阔肌肌皮瓣在肩背部软组织肉瘤扩大切除术后缺损修复中的方便性及优越性。方法:选取临床确诊肩背部软组织肉瘤患者8例,行肩背部病灶扩大切除术后,依据背阔肌肌皮瓣解剖学特点,选择合适的背阔肌肌皮瓣转移修复肩背部缺损。结果:皮瓣全部存活,随访6月至28月,肩背部外形满意,日常活动无明显影响。结论:应用背阔肌肌皮瓣修复肩背部软组织肉瘤扩大术后缺损是一种行之有效的方法。该方法简单易行,临床效果明显。     

背阔肌肌皮瓣修复肩背部软组织肉瘤术后缺损研究

目的：分析背阔肌肌皮瓣在肩背部软组织肉瘤扩大切除术后缺损修复中的方便性及优越性。方法：选取临床确诊肩背部软组织肉瘤患者8例,行肩背部病灶扩大切除术后,依据背阔肌肌皮瓣解剖学特点,选择合适的背阔肌肌皮瓣转移修复肩背部缺损。结果：皮瓣全部存活,随访6月至28月,肩背部外形满意,日常活动无明显影响。结论：应用背阔肌肌皮瓣修复肩背部软组织肉瘤扩大术后缺损是一种行之有效的方法。该方法简单易行,临床效果明显。     

Widely split latissimus dorsi muscle flaps for reconstruction of long soft-tissue defects in lower extremities

Although the latissimus dorsi is one of the largest and longest muscles in the human body, it is still sometimes inadequate for reconstruction of a soft-tissue defect of extensive length and dimension. Eight patients with such lower limb defects were treated with latissimus dorsi muscles split into two hemiflaps sequentially linked, one after the other like a chain. Six transfers were completely successful, one required reexploration for arterial occlusion, and two hemiflaps had a partial loss that could be managed by touching up the skin graft. The average split sequential-link muscle was 42 cm in length. Although two patients had a partial loss, we consider that the widely split single latissimus dorsi muscle can still be used reliably to reconstruct a long slender defect, or two separate, longitudinally located, medium-sized defects in the same leg.