Flow-through Free Latissimus Dorsi Flap for Reconstruction of Injured Limbs

Abstract

Management of vascularized injured extremity requires careful reconstruction for continuity of leg circulation. Protection of the remaining intact vessels during free flap transfer provides condition for blood flow maintenance in the distal extremity. Latissimus dorsi muscle has the correct vessel anatomy for applying flow-through flap because it protects recipient vessel integrity during soft tissue reconstruction. Flow-through flap circulation may cause decreasing blood flow in the recipient artery and steal phenomenon in distal circulation although the main vessel remains intact. The purpose of this study was to describe blood flow changes in the recipient artery, flap pedicle, and distal leg circulation at early and long-term follow- up periods. For this purpose, evaluations of blood flows by using Doppler ultrasonography were performed in 2 vascularized injured extremities which were reconstructed with flow-through free latissimus dorsi musculocutaneous flaps. The results demonstrate that flow-through flaps in our vascularized injured extremity did not disturb distal leg circulation in spite of increased blood flow in the recipient and pedicle arteries.

Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

“…Sensation may possibly be preserved in select cases of relatively proximal injury through the use of fasciocutaneous or musculocutaneous flaps (9). When segmental vascular damage is present or to preserve arterial patency, flow-through flaps provide a novel opportunity for reconstruction without disrupting distal circulation (10)(11)(12). Nevertheless, other factors besides flap utilization continue to be important in formulating an algorithm for treating the traumatized extremity.…”

Salvage of a free radial forearm flap by creation of an arteriovenous fistula at the distal arterial pedicle

“…In the late postoperative period, the recipient blood flow decreased compared with early postoperative period. However, it was still higher than before the free flap transfer . In “arterio‐venous flow throw” flaps as in our case the steal phenomenon could be more serious.…”

Clinical analysis of 33 flow-through latissimus dorsi flaps

“…These two differences can be explained by a difference in the purposes of using flow-through flaps. Whereas in the previous reports, the flow-through flap was used to preserve or reconstruct the continuity of the recipient artery, 4,5,17,18 in our study this aim was of secondary importance. Our foremost aim was to improve the success rate of flap transfers.…”

“…The indications in previous reports have been limited to the reconstruction of distal extremities, such as the forearm, lower leg, hand, and foot. 4,5,17,18 By contrast, we used flow-through LD flaps in areas other than the distal extremities, including the proximal lower extremity (thigh and knee) in five cases, the Flow-through latissimus dorsi flap trunk in seven, and the scalp in seven, although it has been generally thought that the flow-through flap is not necessary for reconstruction in these areas. Second is the nature of the recipient artery.…”

“…In previous reports, authors reported using major arteries (including the ulnar, radial, and tibial arteries) as a recipient artery. 4,5,18 It is preferable to preserve or reconstruct the continuity of these major arteries to maintain adequate circulation in the distal extremity. In our study, more than half of the recipient arteries were not major arteries.…”