Reverse‐supercharged, distally based latissimus dorsi flap for lumbar defect: A case report

Abstract

Well‐vascularized tissue is required for successful reconstruction of a soft tissue defect in the lumbar region. There are several options for reconstruction; however, controversy exists regarding the optimal technique. Here, we present a case of a lumbar defect following tumor resection in a 75‐year‐old patient that was repaired using a reverse‐supercharged, distally based latissimus dorsi flap. The defect of size 15 × 12 cm2 was localized to the lumbar region. An 11 × 7 cm2‐sized, distally based latissimus dorsi flap was designed cephalad to the latissimus dorsi muscle. After the flap was tunneled to the defect, vascular insufficiency of the skin flap was observed. Supercharging was subsequently performed by anastomosing the serratus anterior branch in a reverse manner to the lumbar perforator. The diameters of the vessels at the end‐to‐end anastomosis site were 1.0 mm (artery) and 1.2 mm (vein), respectively, and there was slight discrepancy in their calibers. After microvascular anastomosis, the vascular supply of the flap improved, and the flap survived uneventfully, without venous congestion. The patient was discharged 17 days after the surgery, and no recurrence of the tumor was observed at the 2‐year follow‐up. We report a case of successful salvage of a distally based latissimus dorsi flap by the reverse‐supercharge technique based on a serratus anterior branch. This flap might be a suitable alternative for use in the lumbar region in the case of limited availability of reconstructive choices.

Repair of a large recurrent congenital lumbar hernia with free composite anterolateral thigh flap, tensor fascia lata flap, and vastus lateralis flap and meshes: A case report

“…Treating major defects of trunk with inadequate surrounding tissue, microsurgical flaps might be a solution of choice considering the patient's age, cause of defect, size of defect, deepness of defect, donor site morbidity, and recipient site vascular supply status (Menichini et al, 2020; O'Hare et al, 1983). TFL flaps provide semi‐rigid fascial layer, additional structural supports, and may be served as pedicled or free flaps (Hamada et al, 2019; Menichini et al, 2020). The innervated VL muscle may provide dynamic reconstruction in preventing recurrence of abdominal hernia in the long‐term.…”

Pedicled anterolateral thigh flap transfer for the reconstruction of a large gluteal defect assisted by preoperative computed tomographic angiography and intraoperative indocyanine green angiography: A case report

“…The use of the distally based latissimus dorsi flap for reconstruction of the lumbar region was reported (Grappolini & Fanzio, 2009;Hamada et al, 2019;Kotti et al, 2012;Muramatsu et al, 2006). However, in this procedure, not only is the latissimus dorsi muscle sacrificed, but also supercharging anastomoses of the thoracodorsal vessels might be necessary (Hamada et al, 2019), which also results in demanding postoperative care.…”

“…The use of the distally based latissimus dorsi flap for reconstruction of the lumbar region was reported (Grappolini & Fanzio, 2009;Hamada et al, 2019;Kotti et al, 2012;Muramatsu et al, 2006). However, in this procedure, not only is the latissimus dorsi muscle sacrificed, but also supercharging anastomoses of the thoracodorsal vessels might be necessary (Hamada et al, 2019), which also results in demanding postoperative care. Thus, combining pre-and intraoperative imaging modalities enabled a straightforward pedicled flap transfer for the reconstruction of a relatively distant defect: a precise estimate using preoperative CTA helped predict if a pedicled ALT flap could be used and simulate a flap transfer course; an intraoperative ICG angiography on which the whole flap was enhanced could confirm the use of the ALT flap without additional procedures.…”

Extended latissimus dorsi flap with propeller ascending design for reconstruction of a complex lateral lumbar defect: A case report and review of the literature

“…Lumbar artery perforator (LAP) and intercostal artery perforator (ICAP) flaps have been proposed as well (Kato et al, 1999;Wong et al, 2004) flap is frequently burdened by distal perfusion issues which may cause ischemia to muscular components and overlying skin paddle (Bostwick et al, 1980). In this scenario, to supercharge the flap may ensure survival, enhancing flap perfusion and drainage, despite adding further complexity to the reconstructive strategy (Hamada et al, 2019). Menichini et al (2020) presented the reverse-flow latissimus dorsi myocutaneous flap based on the serratus anterior branch as a salvage procedure in back complex defects reconstruction, despite reliability of flap perfusion must be assessed by temporary closure of TD artery before its ligation.…”