More Experience with the “Reverse” Latissimus Dorsi Musculocutaneous Flap

Stevenson, Thomas R.; Rohrich, Rodney J; Pollock, Richard A.; Dingman, Reed O.; Bostwick, John

doi:10.1097/00006534-198408000-00011

Cited by 81 publications

(43 citation statements)

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“…Its dominant vascular pedicle is the thoracodorsal artery, which is part of the scapular vascular system, whereas the non-dominant pedicles origin from intercostal and lumbar arteries. It is therefore a class V muscle according to the popular classification of Mathes and Nahai [16] ; thus, survival of the flap may also be based on the non-dominant pedicles [17] , which would allow utilization of this flap as a "reverse" flap in order to cover contralateral or more caudal defects [9] . The RLDM flap receives its blood supply from the perforating branches of the intercostal and lumbar arteries [17,18] .…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore a class V muscle according to the popular classification of Mathes and Nahai [16] ; thus, survival of the flap may also be based on the non-dominant pedicles [17] , which would allow utilization of this flap as a "reverse" flap in order to cover contralateral or more caudal defects [9] . The RLDM flap receives its blood supply from the perforating branches of the intercostal and lumbar arteries [17,18] . During flap elevation, all medial muscle origin from the spinous processes of the vertebrae can be released, facilitating inferior transposition of the flap.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, multiple perforators of the medial branches of the posterior intercostal vessels and lumbar arteries can be visualized in the midline of the back. Stevenson et al [17] have demonstrated, that the RLDM flap is mainly nourished by 3 vessels originating from the 9th, 10th, and 11th intercostal arteries and veins located 5 cm from the midline of the back. These perforators can be preserved if they do not limitate flap transfer, otherwise they can also be dissected.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Reverse bilateral latissimus dorsi flap reconstruction after extensive mid back dermatofibrosarcoma protuberans excision: a case report

Bonomi¹,

Sala²,

Gronchi³

et al. 2018

PAR

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Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reverse bilateral latissimus dorsi flap reconstruction after extensive mid back dermatofibrosarcoma protuberans excision: a case report

Bonomi¹,

Sala²,

Gronchi³

et al. 2018

PAR

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“…Latisimus dorsi kas flebi lomber ve üst sırt bölgesi defektlerin onarımlarında hem torakodorsal pedikül (proksimal tabanlı) hem de sekonder segmental pedikül üzerinden (distal tabanlı veya ters akımlı flep) kaldırılarak kullanılabilir. [20][21][22] Olgumuzdaki gibi daha distal defektlerde proksimal tabanlı olarak transferi uygun olmayıp ters veya reverse olarak hazırlanması gerekmekte; ancak, özellikle cilt adası ihtiyacı olduğunda flebin torakodorsal pediküle yakın bölge-lerinde venöz yetmezliğe bağlı yüksek oranda flep kayıpları bildirilmektedir. [23] Bunu önlemek için venöz "supercharge" şeklinde anastomazlar tanımlanmıştır.…”

Section: Discussionunclassified

Using of Pedicled Rectus Abdominis Musculocutaneous Flaps in the Thigh and Lumber Defects

Duymaz¹,

Karabekmez

Keskin

2014

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Daha önce tanımlanmış, fakat az kullanılan "ekstended" veya vertical rektus abdominis muskulokutan ("Ekstended" RAM, VRAM) fleplerinin çok nadir endikasyonlardaki kullanımları incelendi. GEREÇ VE YÖNTEM:Beş hastada, 28x8 ile 35x10 cm ebatlarında cilt adası içeren flepler kullanıldı. Dört flep uyluk ve diz proksimal bölgedeki defekt onarımları için inguinal ligamentin altından, bir flep lomber gölgedeki defekt onarımı için transabdominal olarak defekt alanlara taşındı. BULGULAR:Hiçbir olguda flep kaybı görülmedi. Bir olguda yara yeri enfeksiyonu gelişti ve cerrahi ile tedavi edildi. Uyluk ve lomber bölge defektleri onarımlarında düşük komplikasyon oranlarıyla "ekstended" RAM ve VRAM fleple başarılı transfer gerçekleştirildi ve çok güvenli ve uygun bir seçenek olduğu sunuldu. SONUÇ:Avantajları bol miktarda ve iyi kanlanan doku taşımasını sağlar, flep kolay ve hızlı hazırlanır ve mikrocerrahi deneyimi gerektirmez.Anahtar sözcükler: Pediküllü rektus abdominis kas deri flebi; uyluk ve sırt defektleri. GİRİŞRektus abdominis muskulokutan (RAM) flep Mathes-Nahai sı-nıflamasına göre tip 2 fleptir. Vasküler yapısının güvenli olması, büyük hacimde ve ebatlarda kaldırılabilmesi, pedikülün uzun olmasından dolayı gerek serbest flep olarak gerekse inferior ve superior pediküllü olarak sternal, kasık, perine, pelvik ve vaginal defektlerin onarımlarında kullanılmıştır.[1,2] Ancak uyluk bölgesindeki defekt onarımlarında kullanımı daha az yaygın olup [3][4][5][6][7][8][9] sırt bölgesinde kullanımı oldukça nadirdir. [10][11][12][13][14] Çalışmamızın amacı; uyluk ve sırt bölgesinde doku defektleri olan veya femur orta seviyesinde amputasyon sonrası yeterli yumuşak doku desteği olmayan olgularda RAM flebiyle onarımları sunmak, flep hazırlanışındaki teknik detayları ve flebin avantajlarını literatür eşliğinde tartışmaktır. GEREÇ VE YÖNTEMÇalışmaya Kasım 2012 ve Haziran 2013 yılları arasında inferiyor tabanlı RAM flebi ile onarılan uyluk, sırt bölgesi defektleri ile femur orta seviyesinden amputasyon güdüklerinde yumuşak doku yetersizliği olan hastalar alındı. Flep boyutları, hasta demografileri, hastanede kalış süreleri ve ameliyat sonrası komplikasyonlar incelendi. Cerrahi TeknikTüm hastalara genel anestezi altında ve sırtüstü yatar pozisyondaiken ameliyata başlandı. Flep uyluk bölgesi onarımı için kullanılacak olgularda ipsilateral, sırt defekti olan olgu için ise sağ taraftan planlandı. Defektin ve doku gereksinimine göre VRAM veya "ekstended" RAM şeklinde ve donör alan primer olarak kapatılabilecek şekilde tasarlandı. Cilt ve ciltaltı dokular geçildikten sonra lateralde eksternal oblik fasya üzerinden disseke edildi. Flep tranferi sonrası abdominal bölgedeki fıtık-laşmayı minimize etmek için anterior rektus fasyasına ulaşıl-

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“…3,12 Muscle and musculocutaneous flaps have been successfully used for the reconstruction of MMC defects, and bilateral latissimus dorsi muscle flap, bipedicled thoracolumbar musculocutaneous flap, latissimus dorsi and gluteus maximus muscle advancement flaps, bilateral V-Y musculocutaneous advancement flap, Limberg musculocutaneous flap, and reverse latissimus dorsi muscle flap have all been used. 8,14,15,23,25 Muscle flaps have very good blood circulation in addition to their capacity to provide excellent soft tissue padding. Nevertheless, they also have disadvantages, such as longer duration of operation and increased hemorrhage due to muscle dissection.…”

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confidence: 99%

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

Kankaya

Sungur

Aslan

et al. 2015

PED

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OBJECT Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50–0.66 and 0.16–0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

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More Experience with the “Reverse” Latissimus Dorsi Musculocutaneous Flap

Cited by 81 publications

References 0 publications

Reverse bilateral latissimus dorsi flap reconstruction after extensive mid back dermatofibrosarcoma protuberans excision: a case report

Reverse bilateral latissimus dorsi flap reconstruction after extensive mid back dermatofibrosarcoma protuberans excision: a case report

Using of Pedicled Rectus Abdominis Musculocutaneous Flaps in the Thigh and Lumber Defects

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

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