Reconstruction of the shoulder region using a pedicled latissimus dorsi flap after resection of soft tissue due to sarcoma

Kim, Jin Sam; Lee, Jong Seok; Yoon, Jun O; Park, Jae Bum

doi:10.1016/j.bjps.2007.12.079

Cited by 23 publications

(17 citation statements)

References 16 publications

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“…There are insufficient local/regional flap options for coverage of extensive soft tissue defects around the clavicle. Though LDMF is a versatile option in straightforward cases, it is to be avoided in cases of prior radiotherapy or axillary lymph node dissection [3]. Pectoralis major is an alternative option.…”

Section: Discussionmentioning

confidence: 99%

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Naalla¹,

Raju²,

Sharma³

et al. 2019

IMJ

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IntroductionWide excision of the soft tissue tumors around the clavicle results in extensive defects frequently leading to exposure of critical neurovascular and skeletal structures. Early healing and stable vascularized soft tissue coverage are necessary for adjuvant chemo-radiotherapy in many instances. When the lesions extend to the shoulder region, flap coverage is recommended to prevent wound contraction and restriction of shoulder movements. Very few local/regional options are available for coverage of these extensive soft tissue defects. Free tissue transfer is an alternative option to pedicle flaps. However, there is an increased requirement of operating time, resources, and the risk of total flap loss. The latissimus dorsi myocutaneous flap (LDMF) is a versatile option to cover these defects due to its large vascularized surface area, long vascular pedicle, and less donor site morbidity. The aim of this study is to share our technique and analyze the outcomes in this case series. MethodsRetrospective analysis of seven patients who underwent wide excision of the malignant tumors around the clavicle was done between January 2016 and June 2018. Patient demographics, clinical details, the arc of rotation, outcome, and complications were analyzed. Surgical TechniquesLatissimus dorsi muscle was evaluated by palpating the muscle at the posterior axillary fold while resisting the shoulder adduction during the preoperative workup. Once the malignant lesion was excised and the defect was created by the general surgeon, we took over the patient. The patient was turned into the lateral decubitus position and the latissimus dorsi muscle boundaries were marked. The anterior border of the muscle was marked along the posterior axillary line and the upper border was marked at the tip of the scapula, medially at the spinous process of the vertebra and inferiorly at the posterior aspect of the iliac crest. The skin paddle was designed over the muscle, predominantly over the upper two-thirds of the muscle, to include the high density of myocutaneous perforators. The length and breadth of the defect were noted and Abstract Background: The versatility of pedicled latissimus dorsi (LD) flap is well known for the reconstruction of the breast, upper limb, and trunk defects. Extensive soft tissue defects following oncologic resections around the clavicle are rare and the utility of pedicled LD muscle flap has been less reported.

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Section: Discussionmentioning

confidence: 99%

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Naalla¹,

Raju²,

Sharma³

et al. 2019

IMJ

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“…Transfer of a pedicled latissimus dorsi musculocutaneous flap is the method of choice for reconstructing the skin of the upper back . Advantages include a large, consistent, and reliable vascular pedicle; a highly flexible skin island design; ease of flap elevation; and minimal donor‐site morbidity . The only problem with this flap is that closure of the donor site interferes with closure of the recipient site, which can become enlarged, depending on the orientation of the skin island.…”

Section: Discussionmentioning

confidence: 99%

Efficient design of a latissimus dorsi musculocutaneous flap to repair large skin defects of the upper back

et al. 2013

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Closing large skin defects of the upper back is a challenging problem. We have developed an efficient design for a latissimus dorsi musculocutaneous flap for reconstruction in this region. The longitudinal axis of the skin island was designed to be perpendicular to the line of least skin tension at the recipient site so that primary closure of the flap donor site changed the shape of the recipient site to one that was easier to close. We used this method for four patients with skin cancers or soft-tissue sarcomas of the upper back in 2011 and 2012. The size of skin defects after wide excision ranged from 11 × 10 to 25 × 20 cm(2) , and all skin defects could be covered by the flaps and all wounds of donor site could be closed without skin grafts. No wound complications occurred in any patient. Functional and aesthetic outcomes were satisfactory in all patients. This flap design is effective for reconstructing large skin defects of the upper back.

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“…Absence of the deltoid muscle could be debilitating in a person's normal daily life as the normal arm will be hanging weakly at the shoulder joint with a complete loss of abduction and flexion. A functional muscle transfer using the trapezius, latissimus dorsi, pectoralis muscle, biceps or triceps is essential for the restoration of the shoulder function [2] . Restoration of the shoulder joint function may prevent the need for shoulder arthrodesis and therefore, the patient can still engage in his normal daily life and professional activity.…”

Section: Introductionmentioning

confidence: 99%

Functional deltoid muscle reconstruction following an extensive squamous cell carcinoma resection

Jun

Saad²

2016

J Surg Dermatol

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Squamous cell carcinoma frequently occurs in an individual with albinism. In this case, the growth of the squamous cell carcinoma was aggressive that it invaded the deltoid muscle. After an oncologic resection, there was a huge defect which required near total resection of the deltoid muscle. Loss of deltoid muscle will lead to the loss of abduction and anterior flexion at the shoulder. This could be debilitating in a person's normal daily life and activities. Restoration of the shoulder abduction and flexion function with a pedicle bipolar latissimus dorsi flap transfer was chosen in this case due to the versatility and reliability of the flap.

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Reconstruction of the shoulder region using a pedicled latissimus dorsi flap after resection of soft tissue due to sarcoma

Cited by 23 publications

References 16 publications

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Technique and Outcomes of Pedicled Latissimus Dorsi Myocutaneous Flap for Oncologic Defects Around the Clavicle

Efficient design of a latissimus dorsi musculocutaneous flap to repair large skin defects of the upper back

Functional deltoid muscle reconstruction following an extensive squamous cell carcinoma resection

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