Combined latissimus dorsi and serratus anterior flaps for pelvic reconstruction

Abstract

In recurrent pressure sores, adjacent tissue has already been consumed by multiple surgeries. Additional problems are several co-morbidities of patients. Especially, severe atherosclerosis would be a contraindication for using free flaps. However, microsurgical techniques allow circumventing these limitations and preparing even severely atherosclerotic vessels. We performed a total of eight sacral pressure sore coverage in our standardized fashion, using the free combined latissimus dorsi and serratus anterior free flaps. All patients had severe atherosclerosis and needed large soft tissue coverage of the sacral defects. Five patients presented after bowel resection, three with recurrent sacral pressure sores. The average follow-up was 12 months. Postoperatively, all patients were allowed to be prone on the operated area. One minor wound dehiscence was sutured in local anesthesia. CT imaging analysis of the pelvis showed complete void space coverage. The combined latissimus dorsi and serratus anterior flaps are a valuable tool for pelvic reconstruction in our hands. In addition, severe atherosclerosis should not be considered an obstacle to microsurgery and the use of free flaps.

Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap

“…For reconstruction of the urine bladder wall and to prevent recurrence of the fistula, well‐perfused tissue is necessary in the context after radiotherapy. Regarding this, a well‐vascularized muscle flap, such as the bipedicled latissimus dorsi and serratus anterior muscle flap, is the most promising option, and was chosen here and reported for the first time . In the case of recurrence of the liposarcoma, it would even be possible to harvest the latissimus dorsi flap or even resect parts of it in consideration of the flap pedicle course.…”

Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes

“…While free flaps have been described for pelvic reconstruction, they are generally less favored due to the diminished quality of available recipient vessels. 7,[28][29][30][31] The effect of preoperative radiation therapy on free flap outcomes remains an area of considerable debate. In vitro studies have shown lower patency rates on anastomoses performed on irradiated vessels.…”

Coverage of Giant Sacral Sore With a Gastrocnemius Myocutaneous Flap Pedicled With Femoral Vessels After Thigh Amputation

“…3 Multiple techniques have been described to repair these ulcers, including reconstruction with rotation flaps, island musculocutaneous flaps, V-Y advancement flaps, gluteal thigh flaps, perforator flaps, and free flaps. [4][5][6][7][8][9][10][11][12][13] However, despite successful flap closure, recurrence of the ulcer is common, especially in patients with paraplegia who are dependent on wheelchairs for mobility. [14][15][16] Management of patients with large recurrent sacral pressure ulcerations can be complicated by the unavailability of local flaps, either because they have already been used or because the presence of adjacent lesions makes such flaps insufficient for complete coverage.…”