The Thin Latissimus Dorsi Perforator-Based Free Flap for Resurfacing

Abstract

The authors present their experience with "thin" latissimus dorsi perforator-based free flaps for resurfacing defects. Perforator-based free flaps have been used for various kinds of reconstruction by presenting important donor structures. The thin latissimus dorsi perforatorbased free flap included only the skin and superficial adipose layer to reduce its bulkiness by dissection through the superficial fascial plane. This flap was used in 12 clinical cases, without flap necrosis or other serious postoperative complications. All of the patients were examined by preoperative power Doppler ultrasound in the spectral Doppler mode to search for the most reliable perforator. This noninvasive ultrasound technique determines the exact location and course of and ensures the reliable flow of the perforators; therefore, it greatly assists microsurgeons in saving operation time and in selecting the most suitable design for perforator flap reconstruction. We used perforators that were identified several centimeters from the lateral border of the latissimus dorsi muscle. The thin flap dimensions could be safely designed for flaps measuring up to 20 cm in length and 8 cm in width for primary closure of the donor site. Generally, a long pedicle is not required for resurfacing reconstructions, where small recipient arteries in the bed are acceptable for anastomosis with pedicles. However, pedicle dissection to the proximal vessels through the latissimus dorsi muscle was required when it was necessary to match the recipient vein for anastomosis. The authors conclude that this thin latissimus dorsi perforator-based free flap has great potential for resurfacing because of its constant thickness, easy elevation with the help of power Doppler ultrasound information, and proper flap size for moderate defects caused by scar contracture release, superficial tumor ablation, and so on.

Different Types of Suprafascial Courses in Thoracodorsal Artery Skin Perforators

“…[1][2][3][4][5][6][7][8] It consists of the skin and subcutaneous fat and spares the latissimus dorsi muscle. However, it is too bulky for shallow soft-tissue defects.…”

Super-Thinned Iliac Flap for Major Defects on the Elbow and Wrist Flexion Creases

“…Shortly afterwards, several authors developed techniques to create super-thin free flaps: anterolateral thigh, thoracodorsal, and periumbilical perforator flaps were among the most popular choices. [13][14][15][16][17][18]24 Those flaps, however, do not have a negligible donor site, particularly if a skin graft is needed to cover the donor site. 18 The dermis of the inguinal area is quite thin compared with that of the thigh or back, making it ideally suited for pliability and contour reconstruction as required in a flexion crease.…”

The thoracodorsal vascular tree‐based combined fascial flaps

“…A skin flap based on the thoracodorsal artery perforator can be harvested together with these fascial flaps, when a skin flap is required. 15 In cases of reconstruction of upper extremities where a major artery such as radial or ulnar artery is used as the recipient vessel, the circulation of the major artery can be preserved by raising a skin flap containing either the thoracodorsal artery serratus anterior branch or the latissimus dorsi branch not used in the fascial flap and then anastomosing this branch with the peripheral side of the recipient vessel.…”