The Modified Extended Fleur-De-Lis Latissimus Dorsi Flap for Various Complex Multi-directional Large Soft and Bone Tissue Reconstruction

Abstract

Introduction Latissimus Dorsi (LD) myocutaneous flap is a workhorse flap for various large reconstructions. Variants described to increase its volume are referred to as extended LD flaps. The extended fleur-de-lis LD is one of these variants. We report the clinical outcomes using a modified extended fleur-de-lis LD flap for complex multi-directional soft and bone tissue defects. Methods Between 2010 and 2017, 29 patients underwent the modified extended fleur-de-lis LD flaps, whose sizes were between 120 cm 2 and 442 cm 2. The mean age was 47.55 ± 9.07 years. Locations of the defects included head and neck (nine cases), upper extremity (six cases), lower extremity (nine cases) and chest wall regions (five cases).

“Superman” Latissimus Dorsi Flap for Breast Reconstruction: A Technical Innovation for Covering Extensive Mastectomy Defect

“…The donor site was closed primarily [6]. The fleur-de-lis pattern described by Ciudad et al for extensive soft tissue defects utilizes a modified skin paddle with medial and lateral extensions just above the posterior superior iliac crest [7].…”

“…Various modifications in the design of harvested LD flap skin paddles have been proposed in the literature to overcome the limitation of the size of the skin paddle [5][6][7]. We report a case of carcinoma breast with an extensive post-mastectomy defect, resurfaced with a pedicled LD myocutaneous flap with an S-shaped skin paddle, allowing primary closure of the donor site.…”

Extended Latissimus Dorsi Kite Flap (ELD-K Flap): Revisiting an Old Place for a Total Autologous Breast Reconstruction in Patients with Medium to Large Breasts

“…In their first interesting paper on this topic, they used an ELD flap to cover large defects in the lumbar area while maintaining perfusion through the thoracodorsal pedicle [42]. More recently, they reported a series of more than 20 patients treated with modified extended fleur-de-lis LD flap, both pedicled and as a free flap, in the reconstruction of complex defects [43]. In 2010, through a detailed analysis of the deposition of back fat, Bailey et al [21] described a low transverse extended LD flap harvest technique that increases flap volumes and improves donor-site aesthetics in a selected group of obese patients.…”

Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

“…The extended eur-de-lis LDMC ap is one of the other variants and was rst introduced by McGraw and Papp in 1991 for breast reconstruction, but later it was applied in other reconstructions as well [29] . Pedro Ciudad et al also used modi ed extended eur-de-lis LDMC ap for large defects [30] . This design is similar to the double-wings extended LDMC ap.…”