Latissimus dorsi pedicle flap in soft tissues reconstruction of upper limb

Abstract

Purpose: highlighting possible migration variants of pedicle latissimus dorsi flap at thoracic limb's level and the permissive limits in achievement of the best reconstructive results. Material and methods: pedicle latissimus dorsi flap was performed in 5 cases for tissues defects treatment, being used myocutaneous type. LD flap was used to cover 3 regions of the upper limb: arm - 2 (25%) cases, the elbow joint - 3 (37.5%) cases, proximal third of forearm - 3 (37.5%) cases. The flaps were harvested in the classical way on their thoracodorsal pedicle. The maximum dimensions of tissues defects were 30 x 18 cm. Results: in the study were harvested 5 flaps, none being lost. 3 (60%) flaps survived completely, and in 2 (40%) cases had reached to a point 10 cm up to 15 cm distal to the olecranon without significant elongation of the pedicle. 2 (40%) cases developed marginal distal necrosis of about 5 cm, being carried out necrectomy and skin grafting. In 4 (80%) cases migration paths were sutured during first surgical stage and in 1 (20%) cases – at second surgical stage, using skin grafts. No complications at donor site were reported. Conclusions: This study revealed that latissimus dorsi pedicle flap can be used to cover large skin defects localized on thoracic limb's level, down to the proximal third of the forearm. It can be used up to 60% of the LD surface to cover the defects, without compromising the function of the shoulder. Migration distal from olecranon is not always safe, being accompanied by complications such as marginal necrosis.