The Split Latissimus Dorsi Myocutaneous Flap

Tobin, Gordon R.; Moberg, A; DuBou, Richard H.; Weiner, Leonard J.; Bland, Kirby I.

doi:10.1097/00000637-198110000-00004

Cited by 88 publications

(9 citation statements)

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“…2 Although seeming simple to harvest with a reliable and predictable vascular anatomy, the donor site morbidity remains considerable. The evolution led to the introduction of the split LD flap in the 1980s by Tobin et al, 10 which was latter popularized by many authors proving the reduction in seroma formation and better functional and aesthetic outcome. 8 The introduction of perforator-based flaps has significantly led to the reduction of donor site morbidity.…”

Section: Discussionmentioning

confidence: 99%

Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute

Viscardi

Eseme

Gohritz

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Large arm defects remain a challenge to the reconstructive surgeon, as local and regional flaps are limited regarding size and free flaps have disadvantages such as poor color match, technical complexity, prolonged operative time, and the risk of total flap loss. Keystone flaps are fascia-based flaps and combine perforator-based vascularity with relative simplicity of nonmicrosurgical techniques and do not distort local anatomy in cases of malignant excision with wide defects. This article highlights the approach of a multistaged procedure to reconstruct a large arm defect using a keystone type I flap and a temporary synthetic skin substitute for closure in a patient referred to our department for wide resection of a large melanoma in situ on the posterior aspect of the left arm. The defect, measuring 14 cm × 8 cm, was initially reconstructed with a keystone type I flap. Part of the wound was temporarily covered with EpiGARD (Biovision GmbH, Ilmenau, Germany) to avoid excessive wound tension. One week later, the wound was partially narrowed, and a smaller EpiGARD was placed in office under local anesthesia. The multistaged approach was completed with direct closure 1 week later after removal of the smaller EpiGARD. No complications occurred and the result was satisfactory with a pleasing cosmetic result after an 8-month follow-up. In conclusion, the keystone flap allows reconstruction of large arm defects. Temporary synthetic skin substitute coverage can serve as a good addition for those cases where tension on the margins is observed at the price of a small in-office procedure.

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Section: Discussionmentioning

confidence: 99%

Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute

Viscardi

Eseme

Gohritz

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Other techniques have been developed to overcome these difficulties. With expansion of the original concept of muscle‐preservation in perforator flaps, and to reduce the incidence of partial flap loss, muscle‐sparing LD flaps have been proposed . Sever et al reported that the first musculocutaneous perforator of the TDAP flap usually emerges from a point 8–10 cm inferior to the axillary fold and 1–2 cm behind the lateral border of the LD muscle .…”

Section: Discussionmentioning

confidence: 99%

A modified method for harvesting thoracodorsal artery perforator flaps in a simple and time‐saving approach

et al. 2016

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“…The wounds sustained by our combat casualties represent some of the largest and most challenging cases encountered by modern medicine. The size of these wounds often make them unsuitable for split flaps . The evolving blast mechanism of injury frequently results in coverage challenges on multiple extremities, creating the need for novel coverage techniques and judicious use of host tissue, which may be compromised from injury exposure patterns …”

Section: Discussionmentioning

confidence: 99%

“…The size of these wounds often make them unsuitable for split flaps. 14,15 The evolving blast mechanism of injury frequently results in coverage challenges on multiple extremities, creating the need for novel coverage techniques and judicious use of host tissue, which may be compromised from injury exposure patterns. 2 In the majority of our cases (63%), Gustilo-Anderson IIIB open fractures were the primary surgical indication for free tissue transfer and soft tissue coverage.…”

Section: Discussionmentioning

confidence: 99%

Sequential free tissue transfers for simultaneous upper and lower limb salvage

et al. 2013

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The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients.

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The Split Latissimus Dorsi Myocutaneous Flap

Cited by 88 publications

References 0 publications

Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute

Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute

A modified method for harvesting thoracodorsal artery perforator flaps in a simple and time‐saving approach

Sequential free tissue transfers for simultaneous upper and lower limb salvage

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