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

Abstract

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.

Versatility of the Pedicled Latissimus Dorsi Myocutaneous Flap in Reconstruction of Upper Limb and Trunk Soft Tissue Defects

“…In one of our patients, we had used LDMF for coverage of sternal defect 31 following sternal wound infection. Pedicled LD flap can also be used in the reconstruction of other regions such as head and neck, 32 clavicle, 33 shoulder, 34 and thorax. 35 One of the limitations of our study is we have not use LD flap for these indications.…”