Combined use of ipsilateral latissimus dorsi flap and anterolateral thigh flap to reconstruct extensive trunk defects

Miyamoto, Shimpei; Kageyama, Daisuke; Arikawa, Masaki; Kagaya, Yu; Fukunaga, Yutaka

doi:10.1002/micr.30679

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…The results of the current report suggest that the lower abdominal area can be a versatile donor site for soft tissue reconstruction The popular flaps for soft-tissue reconstruction other than the lower abdominal perforator flaps are the anterolateral thigh flap and the thoracodorsal artery perforator flap (Miyamoto, Arikawa, Kagaya, & Fukunaga, 2019;Miyamoto, Fujiki, Kawai, Chuman, & Sakuraba, 2016;Miyamoto, Fujiki, & Sakuraba, 2015). The lower abdominal perforator flaps are usually thicker than the other two flaps and are not suitable for reconstruction of the distal extremities.…”

Section: Casementioning

confidence: 79%

The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection

2019

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Background Historically, conventional musculocutaneous flaps have been commonly used for reconstruction after soft tissue sarcoma resection, and the use of lower abdominal perforator flaps has not been popular. This report examined the current role of lower abdominal perforator flaps in sarcoma treatment. Methods We reviewed the outcomes of 14 patients (mean age: 46.3 years, range: 18–79 years) who underwent immediate reconstruction with a deep inferior epigastric artery perforator (DIEP) flap or a superficial inferior epigastric artery (SIEA) flap after sarcoma resection. The defects ranged in size from 7 × 6 cm2 to 25 × 22 cm2 (mean: 16.5 × 12.1 cm2). An oblique design was used for pedicled DIEP flaps and a transverse design for free DIEP flaps. Results Free SIEA flaps were used in six patients, pedicled DIEP flaps in five, and free DIEP flaps in three. The flaps ranged in size from 13 × 8 cm2 to 36 × 12.5 cm2 (mean: 23.1 × 9.2 cm2). All DIEP flaps except one were harvested based on one dominant perforator. All flaps survived without vascular compromise. Surgical site infection and seroma occurred at the recipient site in one patient each. No donor‐site complications occurred. Conclusions Lower abdominal perforator flaps can serve as a versatile donor site for reconstruction after sarcoma resection.

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Section: Casementioning

confidence: 79%

The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection

2019

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“…In our initial experience with sarcoma patients, we addressed such complex defects with workhorse flaps such as the ALT flap [ 11 ], because of its relatively constant anatomy, reliable vascularization, long vascular pedicle, and extreme variability in design due to the abundance of perforators and possibility to vary the flap thickness according to the defect. This flap can be raised as a thin flap, which is useful for the reconstruction of regions in which the restoration of the normal range of motion is paramount, like the axilla ( Figure 2 ) or the foot [ 12 ], or, in cases where the is a need to fill a deep dead space. Moreover, as recently described [ 13 ], the ALT flap skin island can be combined with the harvest of the vastus lateralis or rectus femoris muscles to provide functional reconstruction in cases of quadriceps or calf compartments resections [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Lower Abdominal vs. Lateral Thigh Perforator Flaps in Microsurgical Sarcoma Reconstruction: The Aesthetics of Donor Site Matters

Brunetti,

Salzillo,

De Bernardis

et al. 2024

JCM

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Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome and the patient’s perception regarding the donor site in a cohort of patients undergoing microsurgical reconstruction with lateral thigh and lower abdominal perforator flaps. Methods: A retrospective evaluation of all patients who underwent sarcoma reconstruction with flaps harvested from the lower abdominal region (deep inferior epigastric artery perforator flap, superficial circumflex iliac artery perforator flap) or lateral thigh region (anterolateral thigh perforator flap and its variations) was performed. Only patients with defects greater than 100 cm2 were included. Patient demographics and operative variables were recorded, together with complications. Patient satisfaction and quality of life with the donor site were registered using the SCAR-Q questionnaire, which was administered at least six months post-operatively. Results: Eighteen anterolateral thigh (ALT) perforator flaps and twenty-two deep inferior epigastric artery perforator (DIEP) and superficial circumflex iliac artery perforator (SCIP) flap procedures were performed. The two groups were homogeneous for major post-operative complications (p > 0.999). Patient satisfaction with the donor site measured using the SCAR-Q questionnaire showed significantly higher scores in the DIEP/SCIP group when compared with the thigh group (p < 0.001), indicating a superiority of the lower abdominal area as an aesthetic donor site. Conclusions: The DIEP and SCIP flaps are a versatile option for reconstructing large soft-tissue defects following sarcoma resection. Therefore, flaps harvested from the lower abdomen yield a higher patient satisfaction with the donor site, which is a feature worth considering when planning a reconstructive procedure.

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“…Besides its locomotor and postural functions, the latissimus dorsi has an importance in reconstructive surgery [ 10 ]. The utilization of a latissimus dorsi flap is a viable treatment modality for repairing extensive soft-tissue defects of the head, neck, and torso [ 11 , 12 ]. This technique is highly advantageous due to its pliability and versatility, providing an optimal solution for a variety of reconstructive surgery procedures [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Absence of the Latissimus Dorsi: A Report of a Rare Case

Erdem¹,

Çevik²,

Şafak³

et al. 2023

Cureus

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The latissimus dorsi is the largest muscle in the human body, located in the lower posterior thorax, and it contributes to motion in the upper extremity and provides assistance in respiration. This case report describes a rare occurrence of a unilateral absence of the latissimus dorsi accompanied by contralateral scoliosis in a 73-year-old female cadaver. The absence of the muscle along with the absence of the thoracodorsal nerve and branches of the subscapular and axillary arteries was identified during a standard dissection course. The implications of this rare case extend to an array of surgical interventions, including head, neck, breast, and torso reconstructive applications. It is important to investigate potential anomalies of the latissimus dorsi, while planning or performing free flap transfers. The report also highlights the importance of understanding this variation for educational and research purposes.

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Combined use of ipsilateral latissimus dorsi flap and anterolateral thigh flap to reconstruct extensive trunk defects

Cited by 5 publications

References 11 publications

The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection

The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection

Lower Abdominal vs. Lateral Thigh Perforator Flaps in Microsurgical Sarcoma Reconstruction: The Aesthetics of Donor Site Matters

Unilateral Absence of the Latissimus Dorsi: A Report of a Rare Case

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