Latissimus dorsi flap in reconstruction of the soft-tissue defects of the trunk

Abstract

Background. The purpose of clinical case presentation is to show potency of utilization latissimus dorsi flap in reconstraction of massive soft-tissue defect on the level of trunk.The use of a pedicled latissimus dorsi flap for reconstruction of large soft-tissue defects following musculoskeletal tumor excision provides adequate well-vascularized and healthy tissue to maximize the chances of successful mobility and minimize the risks of postoperative complications.The latissimus dorsi muscle flaps offers great variety and options to cover large defects in the mid-thoracic and upper-thoracic posterior trunk. It can be raised up to 30 cm × 40 cm in size and may be transferred as a muscular (eventually with additional skin grafts) or myocutaneous flap. The latter option makes postoperative monitoring considerably easier. Case report. We will present a clinical case of 60-year-old woman,who was admitted in Department of Traumatology IMU with tegumentary defect, keratinized carcinoma of the back skin. According to the patient, she is considered sick from 2013, when the first signs of the disease appeared ( on the background of the post-combustion scar presenting in the patient from the age of 3 years at the level of the upper back region). Locally were signs of hyperemia, hyperthermia, discomfort, pronounced pain. The patient underwent a histological examination in The Oncological Institute, May 2015, being diagnosed with: Carcinoma, keratinized pavements of the back skin. During June and July 2015 followed 2 radiotherapy treatments without positive response. On 15.09.2015 being operated at OI (excision of the formation) the post-operated period had a negative evolution.The surgical operation repeated on 12.10.2015, p/o period evolved with decisional suture threads and formation of tegumentary defect about 20x10cm. Considering the entire history of disease in Department of Traumatology III decided to perform the excision of the infected malignant outbreak from the back region and defect plasticity with Latissimus dorsi insular flap. We performed the oncological exesis of the malignant outbreak at a distance from the malignant edges of the defect at about 2-3cm .The actual defect obtained after exertion was 20x35 cm.The donor site of the flap was closed secondarily with a skin graft. Postoperatively: marginal necrosis of the flap that was resolved by excision of the necrotizing area and suturing of the wound, 2 weeks after plastic surgery. The complete treatment of the patient took place 40 days. At 3 years after the surgery the patient presents with a good result. Conclusions. Use of the pedicled latissimus dorsi flap in reconstructions provide sample wellvascularized soft tissue, minimizes the risk of infection and maximizes succesfful mobility salvage. For the same anatomic reasons of easy elevation and rotation, the pedicle latissimus dorsi flap has been used successfully in extensive soft-tissue defects. The satisfactory data of such plastic recovery operations were clinically confirmed.