Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zhiyuan ,  TANG Xiujun , WANG Dali , WEI Zairong , JIN Wenhu , DENG Chengliang , QI Jianping

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China;

Corresponding?author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Latissimus dorsi muscle flap; Kiss flap; deltoid; functional reconstruction; wound repair

DOI：

10.7507/1002-1892.201704047

Video：

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Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S₁ in 2 cases, S₂ in 6 cases, S₃ in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.

Citation： LIU Zhiyuan, TANG Xiujun, WANG Dali, WEI Zairong, JIN Wenhu, DENG Chengliang, QI Jianping. Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1106-1110. doi: 10.7507/1002-1892.201704047 Copy

1.	任高宏, 胡稷杰, 裴國獻. 倒" Y”形血管吻合游離皮瓣移植在肢體創面修復與功能重建中的應用. 中華顯微外科雜志, 2012, 35(1): 27-31.
2.	趙茹, 喬群, 柳成, 等. 背闊肌分區的解剖及臨床應用. 中國修復重建外科雜志, 2003, 17(1): 38-40.
3.	沈余明, 馬春旭, 胡驍驊, 等. 膝關節周圍嚴重皮膚軟組織缺損的組織瓣修復策略. 中華燒傷雜志, 2015, 31(5): 331-336.
4.	Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsimyocutaneous flap in breastreconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5.	彭濤, 劉元波, 臧夢青, 等. 聯合多個預擴張帶蒂軸型皮瓣修復上肢大面積皮膚軟組織缺損的臨床應用. 中華美容整形外科雜志, 2015, 26(10): 620-624.
6.	Zhang YX, Hayakawa TJ, Levin LS, et al. The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7.	Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
8.	呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌 Kiss 皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
9.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
10.	Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
11.	Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
12.	Hwang JH, Kim ES, Kim KS, et al. Latissimus dorsi muscle and its short perforator-based skin compound free flap. Ann Plast Surg, 2007, 58(4): 381-387.
13.	梁尊鴻, 潘云川, 林志琥. 帶蒂背闊肌肌皮瓣早期修復頸部電燒傷深度創面. 組織工程與重建外科雜志, 2016, 12(5): 297-299.
14.	唐舉玉, 李康華, 劉俊, 等. 背闊肌皮瓣游離移植修復下肢巨大軟組織缺損. 中國修復重建外科志, 2006, 20(11): 1087-1089.
15.	胡祖良, 張元海, 倪良方, 等. 帶蒂背闊肌皮瓣轉移修復 Ⅳ 度燒傷創面. 浙江臨床醫學, 2016, 18(3): 469-450.
16.	韋平歐, 譚海濤, 江建中, 等. 背闊肌皮瓣移植重建屈肘屈指功能 11 例. 中華顯微外科志, 2011, 34(6): 494-495.
17.	Boa O, Servant JM, Revol M, et al. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction. Tech Hand Up Extrem Surg, 2011, 15(3): 166-171.
18.	Muramatsu K, Ihara K, Tominaga Y, et al. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthet Surg, 2014, 67(7): 916-920.
19.	Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg, 1986, 78(3): 336-344.
20.	李鋼, 李小兵, 劉子健, 等. 背闊肌肌皮瓣修復肩部皮膚及三角肌缺損十例. 中華燒傷雜志, 2014, 30(4): 370-372.
21.	Dancey AL, Cbeema M, Thonmas SS, et al. A prospective randomized trial of the efficacy of marginal quitting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
22.	Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
23.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
24.	王欣, 潘佳棟, 胡皓良, 等. 分葉型穿支皮瓣在四肢皮膚軟組織缺損修復中的臨床應用. 中華顯微外科雜志, 2013, 36(4): 327-330.
25.	王朝陽, 章一新, 王丹茹, 等. 雙葉背闊肌肌皮瓣修復大面積深部組織缺損. 上海交通大學學報(醫學版), 2012, 32(5): 633-637.
26.	唐修俊, 魏在榮, 王波, 等. 游離旋股外側動脈穿支 KISS 皮瓣修復四肢創面的臨床應用. 中華顯微外科雜志, 2015, 38(1): 29-32.

1. 任高宏, 胡稷杰, 裴國獻. 倒" Y”形血管吻合游離皮瓣移植在肢體創面修復與功能重建中的應用. 中華顯微外科雜志, 2012, 35(1): 27-31.
2. 趙茹, 喬群, 柳成, 等. 背闊肌分區的解剖及臨床應用. 中國修復重建外科雜志, 2003, 17(1): 38-40.
3. 沈余明, 馬春旭, 胡驍驊, 等. 膝關節周圍嚴重皮膚軟組織缺損的組織瓣修復策略. 中華燒傷雜志, 2015, 31(5): 331-336.
4. Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsimyocutaneous flap in breastreconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5. 彭濤, 劉元波, 臧夢青, 等. 聯合多個預擴張帶蒂軸型皮瓣修復上肢大面積皮膚軟組織缺損的臨床應用. 中華美容整形外科雜志, 2015, 26(10): 620-624.
6. Zhang YX, Hayakawa TJ, Levin LS, et al. The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7. Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
8. 呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌 Kiss 皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
9. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
10. Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
11. Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
12. Hwang JH, Kim ES, Kim KS, et al. Latissimus dorsi muscle and its short perforator-based skin compound free flap. Ann Plast Surg, 2007, 58(4): 381-387.
13. 梁尊鴻, 潘云川, 林志琥. 帶蒂背闊肌肌皮瓣早期修復頸部電燒傷深度創面. 組織工程與重建外科雜志, 2016, 12(5): 297-299.
14. 唐舉玉, 李康華, 劉俊, 等. 背闊肌皮瓣游離移植修復下肢巨大軟組織缺損. 中國修復重建外科志, 2006, 20(11): 1087-1089.
15. 胡祖良, 張元海, 倪良方, 等. 帶蒂背闊肌皮瓣轉移修復 Ⅳ 度燒傷創面. 浙江臨床醫學, 2016, 18(3): 469-450.
16. 韋平歐, 譚海濤, 江建中, 等. 背闊肌皮瓣移植重建屈肘屈指功能 11 例. 中華顯微外科志, 2011, 34(6): 494-495.
17. Boa O, Servant JM, Revol M, et al. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction. Tech Hand Up Extrem Surg, 2011, 15(3): 166-171.
18. Muramatsu K, Ihara K, Tominaga Y, et al. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthet Surg, 2014, 67(7): 916-920.
19. Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg, 1986, 78(3): 336-344.
20. 李鋼, 李小兵, 劉子健, 等. 背闊肌肌皮瓣修復肩部皮膚及三角肌缺損十例. 中華燒傷雜志, 2014, 30(4): 370-372.
21. Dancey AL, Cbeema M, Thonmas SS, et al. A prospective randomized trial of the efficacy of marginal quitting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
22. Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
23. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
24. 王欣, 潘佳棟, 胡皓良, 等. 分葉型穿支皮瓣在四肢皮膚軟組織缺損修復中的臨床應用. 中華顯微外科雜志, 2013, 36(4): 327-330.
25. 王朝陽, 章一新, 王丹茹, 等. 雙葉背闊肌肌皮瓣修復大面積深部組織缺損. 上海交通大學學報(醫學版), 2012, 32(5): 633-637.
26. 唐修俊, 魏在榮, 王波, 等. 游離旋股外側動脈穿支 KISS 皮瓣修復四肢創面的臨床應用. 中華顯微外科雜志, 2015, 38(1): 29-32.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap

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