Pedicled Latissimus Dorsi Flap for Complex Arm Defects: A Report of Twenty Cases from Two Centers | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 17, Volume 43, Issue 1, January 2019, Pages 101-105 PDF (14.08 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2019.65167 | ||
| Authors | ||
| Hazem El Tayeb* 1; Emad Salah1; Ashraf Mostafa1; Munira Bin Nakhl2 | ||
| 1The Plastic Surgery Unit, General Surgery Department, Faculty of Medicine, Zagazig University | ||
| 2Adan Hospital, Ministry of Health, Kuwai | ||
| Abstract | ||
| Introduction: The reconstruction of extensive defects of the upper limb are challenging regarding both coverage and function. Latissimus dorsi is a suitably located muscle for resurfacing defects in the arm, elbow and forearm especially with exposure of the vital structures. It is a large flap, with a long pedicle and can be used as a muscle or musculocutaneous flap. Aim of the Work: Evaluate the role of pedicled latissimus dorsi flap in reconstruction of complex posttraumatic arm defects. Patients and Methods: Pedicled Latissimus dorsi flaps with split thickness skin graft were used to reconstruct 20 arm defects. The study were performed in two plastic surgery units in Egypt and Kuwait. Overall flap survival and postoperative complications were used as outcome measures. Results: None of our flap was totally necrosed. Two cases (10%) developed partial necrosis and partial graft loss occurred in 2 cases (10%). Donor site seroma formation was seen in 4 cases (20%). Four cases developed stretching of the scar. Followup ranged from (6-24 months), in which Latissimus dorsi healed perfectly, atrophied and contoured well with a cosmetically satisfactory result. No functional deficit developed from the loss of the latissimus dorsi. Conclusion: Pedicled latissimus dorsi flap is reliable, versatile, and could be the primary choice for reconstruction of post traumatic large complex arm defects. | ||
| Keywords | ||
| Soft tissue defects – Arm – Latissimus dorsi; muscle – Pedicled flap | ||
| References | ||
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1- Tan O., Atik B. and Ergen D.: Versatile use of the pedicled latissimus dorsi flap as a salvage procedure in reconstruction of complex injuries of the upper extremity. Ann. Plast. Surg., 59: 501-506, 2007. 2- Sajjad Y., Hameed A., Gill N.A. and Bhutto A.W.: Use of A Pedicled Flap for Reconstruction of Extensive Soft Tissue Defects Around Elbow. J. Coll. Physicians Surg. Pak., 20 (1): 47-50, 2010. 3- Herter F. and Ninkovic M.: Rotational flap selection and timing for coverage of complex upper extremity 106 Vol. 43, No. 1 / Pedicled Latissimus Dorsi Flap for Complex Arm Defects trauma. J. Plastic. Reconstr. Aesthet. Surg., 60: 760- 768, 2007. 4- Mohanty N. and Nayak B.B.: Pedicled latissimus dorsi flap for arm defects: A report of twenty-three cases. J. Orthop. Traumatol. Rehabil., 7: 145-149, 2014. 5- Abo-Hashem A. and Zakaria Y.: Role of Latissimus Dorsi Island Flap in Coverage of Mutilating Upper Limb Injuries in Pediatric Age Group. Annals of Pediatric Surgery., 6 (3): 154-160, 2010. 6- Nasr M., Abo-Hashem A. and Anany R.: Role of Denervated Latissimus Dorsi Island Flap in Reconstruction of Complex Elbow Injuries. Egypt, J. Plast. Reconstr. Surg., 36 (2): 209-213, 2012. 7- Pierce T.D. and Tomaino M.M.: Use of the pedicled latissimus muscle flap for upper extremity reconstruction. J. Am. Acad. Orthop. Surg., 8: 324-331, 2000. 8- Mordick T.G., Britton E.N. and Brantigan C.: Pedicled latissimus dorsi transfer for immediate soft-tissue coverage and elbow flexion. Plast. Reconstr. Surg., 99: 1742-1744, 1997. 9- Ma C.H., Tu U.K., Wu C.H., et al.: Reconstruction of upper extremity large soft tissue defects using latissimus dorsi muscle flap-technique illustration and clinical outcomes. Injury, 39 (Oct; Suppl.), 4: 67-74, 2008. 10- Lai M.F., Milroy B.C. and Pennington D.G.: Shoulder defect cover with functional restoration using the latissimus dorsi myocutaneous flap: A case report. Br. J. Plast. Surg., 35: 140-143, 1982. 11- Itoh Y., Sasaki T., Ishiguro T., Uchinishi K., Yabe Y. and Fukuda H.: Transfer of latissimus dorsi to replace a paralysed anterior deltoid. A new technique using an inverted pedicled graft. J. Bone Joint Surg. Br., 69: 647- 751, 1987. 12- Ferrier J.A., Owens T. and Singer D.I.: Functional reconstruction of the shoulder with a latissimus dorsi pedicle flap and a hemiarthroplasty: A case report. J. Hand Surg. Am., 20: 284-287, 1995. 13- Stern P.J. and Carey J.P.: The latissimus dorsi flap for reconstruction of the brachium and shoulder. J. Bone Joint Surg. Am., 70: 526-535, 1988. 14- Minami A., Ogino T., Ohnishi N. and Itoga H.: The Latissimus dorsi musculocutaneous flap for extremity reconstruction in orthopedic surgery. Clin. Orthop., 260: 201-206, 1990. 15- Bailey B.N. and Godfrey A.M.: Latissimus dorsi muscle free flaps. Br. J. Plast. Surg., 35: 47-52, 1982. 16- Stevenson T.R., Duus E.C., Greene T.L. and Dingman R.O.: Traumatic upper arm defect treated with latissimus dorsi muscle transposition. J. Pediatr. Orthop., 4: 111- 113, 1984 | ||
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