Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Abstract

Background:Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging.Methods:Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3).Results:The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred.Conclusions:The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds.

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“…Some authors have reported that the interval should be approximately 3 to 12 months. 14,27 In our cases, six patients received secondary cranioplasty. Yoshioka performed cranioplasty within 3 months of debridement.…”

“…Some authors have reported successful scalp reconstruction using free flap transfer. [14][15][16][17] Free flap transfer is useful for patients with large scalp and soft tissue defects. To perform secondary cranioplasty safely, the cause of infection should be preoperatively eliminated.…”

En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach

“…The LD free flap combined with a STSG has the disadvantage of changing patient position during flap harvesting. 25 However, we were able to avoid patient reposition during harvest of the serratus anterior flap due to the use of lateral decubitus positioning and contralateral Mayfield pins in the cranium.…”

Two‐stage free flap reconstruction of the scalp and calvaria for large neurosurgical resections

“…Some complications involve partial necrosis and occasional failure of the entire free flap (4%) (Khoury et al, ), while the rate is 6% when head and neck reconstruction are included (Van Driel et al, ). When free flap is needed for large scalp and calvaria reconstruction complications rate is higher (Afifi et al, ; Hierner, van Loon, Goffin, & van Calenbergh, ; O'Connell, Teng, Mendez, & Futran, ; Scaglioni & Giunta, ; Wang et al, ; Yoshioka, ).…”