Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction

Abstract

Background: The free split latissimus dorsi flap for lower-extremity reconstruction has some advantages over the traditional latissimus dorsi flap. The flap is harvested with the patient in the supine position and is associated with minimal morbidity as the function of the remaining latissimus dorsi muscle is preserved through the posterior division of the thoracodorsal nerve. Methods: A consecutive single-surgeon 5-year series of free split latissimus dorsi muscle flaps for lower-extremity reconstruction (n = 42) was evaluated. Donor site morbidity was evaluated through assessment of the strength of the remaining latissimus dorsi at least 1 month after surgery. Shoulder function was evaluated postoperatively using the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Pain and Disability Index (SPADI). Results: The mean age of the 42 patients was 40.7 years. The mean length and width of the flaps were 17.9 cm and 8.6 cm. The majority (71%) of the wounds were due to acute trauma. Of the 42 flap procedures performed, 95% (40) were successful. Assessment of remaining latissimus dorsi strength at least 1 month postoperatively, during 3 activities, showed a Medical Research Council (MRC) grade of 5 in all patients. The mean and median scores were 6.4 and 0 according to the DASH, 6.0/6.4 and 0/0 on the SPADI pain/disability scales, and 90.7 and 100 on the ASES. Conclusions: The free split latissimus dorsi flap is a large reliable muscle flap with negligible donor site morbidity that is particularly advantageous for lower-extremity resurfacing following trauma. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle‐splitting free flaps

“…The MRC grade was symmetric when compared to the unoperated side and none of the patients complained of difficulty in getting into their wheelchair. The function of the remaining LD muscle remained comparable to the contralateral side, a result consistent with other papers on muscle‐sparing LD harvest (Chim et al, 2020; Saint‐Cyr et al, 2009). Moreover, our muscle‐splitting technique preserves maximum functioning of the remaining muscle by not only saving the transverse nerve branch, but also using the minimum amount of muscle around the bifurcation point.…”

“…At postoperative 6 month, the function of the shoulder was assessed using the Medical Research Council (MRC) grades, which aim to evaluate muscle strength against gravity or resistance (Garusi et al, 2016). Extension and adduction of the shoulder, which relates to LD muscle function, was evaluated by (1) raising the arm upward in prone position with the arm at one's side and (2) shoulder adduction starting at 90′ of abduction (Chim et al, 2020; Garusi et al, 2016).…”

Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

“…One of the biggest concerns regarding the application of extended LD flaps is donor site functional loss because of the need to harvest a large volume of latissimus dorsi muscle 33 . The muscle‐sparing descending branch latissimus dorsi flap and split LD flap may be a useful method to reduce donor site complications, and this flap is recommended if the wound is not extensive 34 , 35 .…”

Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps

“…9,10 We described our experience with the free anterior branch split latissimus dorsi flap, with minimal donor-site morbidity because of preservation of the posterior branch of the thoracodorsal nerve. 1 Compared to the traditional full latissimus dorsi flap, the split latissimus dorsi flap can be harvested from the supine position, and is thin and well-suited for use in extremity reconstruction where the defect is smaller and can be covered with a split latissimus dorsi flap. Preservation of the posterior axillary fold also results in better symmetry and contour of the back.…”

“…he latissimus dorsi flap is considered a "workhorse" for general and breast reconstruction. [1][2][3] Over the years, variations in flap harvest have expanded the reconstructive approaches available. [4][5][6][7][8] In 1981, Tobin et al first introduced the concept of a split latissimus dorsi flap, through the bifurcation of the thoracodorsal artery into its anterior and posterior divisions.…”