Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUI Taotao , LI Fengfeng , WU Yongwei , LIU Jun , MA Yunhong ,  RUI Yongjun

Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China;

Corresponding?author：

RUI Yongjun, Email: ruiyj@hotmail.com

Keywords：

Latissimus dorsi flap; extra-long flap; intercostal artery; limb wound

DOI：

10.7507/1002-1892.201805042

Video：

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Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.

Citation： HUI Taotao, LI Fengfeng, WU Yongwei, LIU Jun, MA Yunhong, RUI Yongjun. Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1572-1575. doi: 10.7507/1002-1892.201805042 Copy

1.	劉昌雄, 唐舉玉, 劉鳴江, 等. 背闊肌皮瓣游離移植修復小兒四肢遠端巨大軟組織缺損. 中華顯微外科雜志, 2010, 33(4): 350.
2.	沈勇, 王彥生, 林澗, 等. 應用游離背闊肌皮瓣治療四肢軟組織缺損. 中華顯微外科雜志, 2012, 35(6): 516.
3.	潘小平, 許祥明, 鄭功勝. 背闊肌皮瓣游離移植修復下肢軟組織缺損的臨床分析. 中華顯微外科雜志, 2010, 33(5): 402-403.
4.	李黎明, 李桂石, 林峰, 等. 胸背動脈前鋸肌支為蒂逆行背闊肌皮瓣的臨床應用. 中華顯微外科雜志, 2010, 33(5): 401-402.
5.	劉志遠, 唐修俊, 王達利, 等. 背闊肌 Kiss 皮瓣修復上臂復合組織缺損及功能重建. 中國修復重建外科雜志, 2017, 31(9): 1106-1110.
6.	Dennis M, Granger A, Ortiz A, et al. The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty. Clin Anat, 2018, 31(2): 152-159.
7.	楊林, 劉宏君, 張文忠, 等. 改良股前外側游離穿支皮瓣橋式交叉移植修復小腿中下段軟組織缺損. 中國修復重建外科雜志, 2017, 31(10): 1240-1244.
8.	李海, 鄧呈亮, 魏在榮, 等. 分葉股前外側穿支皮瓣在血管蒂保護中的作用研究. 中國修復重建外科雜志, 2017, 31(10): 1245-1249.
9.	宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
10.	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. 中國修復重建外科雜志, 2006, 20(11): 1087-1089.
11.	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.
12.	Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-48.
13.	Takagi S, Oyama T, Yamazumi K, et al. Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel: a preliminary report. J Plast Surg Hand Surg, 2013, 47(2): 123-125.
14.	Hokin JA. Mastectomy reconstruction without a prosthetic implant. Plast Reconstr Surg, 1983, 72(6): 810-818.
15.	Papp C, McCraw JB. Autogenous latissimus breast reconstruction. Clin Plast Surg, 1998, 25(2): 261-266.
16.	Germann G, Steinau HU. Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg, 1996, 97(3): 519-526.
17.	Chang DW, Youssef A, Cha S, et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg, 2002, 110(3): 751-761.
18.	Kim CY, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps. Plast Reconstr Surg, 2012, 130(1): 135-144.

1. 劉昌雄, 唐舉玉, 劉鳴江, 等. 背闊肌皮瓣游離移植修復小兒四肢遠端巨大軟組織缺損. 中華顯微外科雜志, 2010, 33(4): 350.
2. 沈勇, 王彥生, 林澗, 等. 應用游離背闊肌皮瓣治療四肢軟組織缺損. 中華顯微外科雜志, 2012, 35(6): 516.
3. 潘小平, 許祥明, 鄭功勝. 背闊肌皮瓣游離移植修復下肢軟組織缺損的臨床分析. 中華顯微外科雜志, 2010, 33(5): 402-403.
4. 李黎明, 李桂石, 林峰, 等. 胸背動脈前鋸肌支為蒂逆行背闊肌皮瓣的臨床應用. 中華顯微外科雜志, 2010, 33(5): 401-402.
5. 劉志遠, 唐修俊, 王達利, 等. 背闊肌 Kiss 皮瓣修復上臂復合組織缺損及功能重建. 中國修復重建外科雜志, 2017, 31(9): 1106-1110.
6. Dennis M, Granger A, Ortiz A, et al. The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty. Clin Anat, 2018, 31(2): 152-159.
7. 楊林, 劉宏君, 張文忠, 等. 改良股前外側游離穿支皮瓣橋式交叉移植修復小腿中下段軟組織缺損. 中國修復重建外科雜志, 2017, 31(10): 1240-1244.
8. 李海, 鄧呈亮, 魏在榮, 等. 分葉股前外側穿支皮瓣在血管蒂保護中的作用研究. 中國修復重建外科雜志, 2017, 31(10): 1245-1249.
9. 宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
10. 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. 中國修復重建外科雜志, 2006, 20(11): 1087-1089.
11. 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.
12. Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-48.
13. Takagi S, Oyama T, Yamazumi K, et al. Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel: a preliminary report. J Plast Surg Hand Surg, 2013, 47(2): 123-125.
14. Hokin JA. Mastectomy reconstruction without a prosthetic implant. Plast Reconstr Surg, 1983, 72(6): 810-818.
15. Papp C, McCraw JB. Autogenous latissimus breast reconstruction. Clin Plast Surg, 1998, 25(2): 261-266.
16. Germann G, Steinau HU. Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg, 1996, 97(3): 519-526.
17. Chang DW, Youssef A, Cha S, et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg, 2002, 110(3): 751-761.
18. Kim CY, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps. Plast Reconstr Surg, 2012, 130(1): 135-144.

Chinese Journal of Reparative and Reconstructive Surgery

Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair

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