Microsurgical reconstruction of extensive lower extremity defects with the conjoined parascapular and latissimus dorsi free flap

Abstract

Background Extensive lower extremity soft‐tissue defects pose a reconstructive challenge. We present our experience with the conjoined parascapular and latissimus dorsi (CPLD) free flap. Methods From October 2008 to October 2017, 69 patients (14 female, 55 male) with a mean age of 50 years (range: 16–79 years) underwent reconstruction of lower extremity defects with the CPLD free flap. Mean defect size was 24 × 36 cm (range: 14 × 20 to 45 × 80 cm). Results Mean latissimus dorsi (LD) flap size was 19 × 28 cm (range: 14 × 20 to 28 × 42 cm) and mean parascapular (PSC) flap size was 8 × 25 cm (range: 5 × 12 to 11 × 33 cm). Six patients (9%) experienced a total of eight microvascular complications: arterial thrombosis (n = 1), venous thrombosis (n = 6), combined arterial and venous thrombosis (n = 1). The re‐exploration rate was 13%. Major complications of the donor‐site were seen in 9 patients (13%), of the flap in 13 patients (19%), and of both in 6 patients (9%). Fifteen patients experienced partial flap necrosis (22%). Three CPLD and one PSC flap were lost (5%). PSC flap length was a significant predictor of distal flap necrosis (χ2(1) = 13.2, p = .004, OR = 1.343, 95% CI [1.098–1.642]). PSC flap width was a significant predictor of donor‐site revisions (χ2(1) = 15.9, p = .010, OR = 4.745, 95% CI [1.584–14.213]). Arterio‐venous loops (AVLs) tended to increase the risk of microvascular thrombosis (χ2(1) = 3.7, p = .08, OR = 4.1, 95% CI [0.9–18.7]). Conclusions The CPLD free flap is an extremely large and highly reliable flap, allowing one‐stage reconstruction of extensive lower extremity defects. It may overcome the need for multiple flaps in selected cases.

Melatonin Improved the Survival of Multi-Territory Perforator Flaps by Promoting Angiogenesis and Inhibiting Apoptosis via the NRF2/FUNDC1 Axis

“…However, the uncertainty blood supply of multi-territory perforator flaps can lead to 5.9 to 22 percent rate of flap necrosis. ( Okşar et al, 2001 ; Chang et al, 2004 ; Bigdeli et al, 2020 ; Salibian et al, 2021 ), and which can result in longer hospital stays, second operation, and more treatment cost ( Tang et al, 2013 ; Qing et al, 2015 ). Hence, improving the survival of multi-territory flaps has vital clinical significance.…”

A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome

“…The defect measured 22 × 20 cm. ( c ) Defect reconstruction was achieved by use of a free conjoined parascapular and latissimus dorsi flap, which was anastomosed to the right internal mammary and vein in an end-to-end fashion [ 13 ]. ( d ) The result at 4-month follow-up.…”

The turbocharged wide anterolateral thigh perforator flap to reconstruct massive soft tissue defects in traumatized lower extremities: A case series

“…There have been several reports on free flap options for reconstructing extensive soft tissue defects in the lower extremities (3)(4)(5)(6)(7)(8)(9). Diverse reconstructive options using a single tissue or a combination of various body tissues have been introduced in these reports; however, the anterolateral thigh perforator (ALTP) flap is currently recognized as the most promising choice owing to its proven vascular reliability and versatility (10)(11)(12)(13)(14).…”