Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian , ZHENG Yucen , XIAO Shune ,  WEI Zairong , NIE Kaiyu , LIU Zhiyuan , CHANG Shusen , JIN Wenhu , CHEN Wei , ZHANG Fang

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

Corresponding?author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Folding; latissimus dorsi; myocutaneous flap; wound repair

DOI：

10.7507/1002-1892.202310013

Video：

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Objective To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back. Methods Between August 2018 and January 2023, the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients. There were 5 males and 3 females with the age ranged from 21 to 56 years (mean, 35.4 years). Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases. The causes of injury were chronic infection of skin and bone exposure in 2 cases, secondary wound after extensive resection of skin and soft tissue tumor in 4 cases, and wound formation caused by traffic accident in 2 cases. Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm. The disease duration ranged from 12 days to 1 year (median, 6.6 months). A pedicled latissimus dorsi myocutaneous flap was designed and harvested. The flap was divided into A/B flap and then were folded to repair the wound, with the donor area of the flap being pulled and sutured in one stage. Results All 7 flaps survived, with primary wound healing. One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change. The incisions of all donor sites healed by first intention. All patients were followed up 6 months to 4 years (mean, 24.7 months). The skin flap has a good appearance with no swelling in the pedicle. At last follow-up, 6 patients had no significant difference in bilateral shoulder joint motion, and 2 patients had a slight decrease in abduction range of motion compared with the healthy side. The patients’ daily life were not affected, and linear scar was left in the donor site. Conclusion The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation, less damage to the donor site, and quick recovery after operation.

Citation： ZHOU Jian, ZHENG Yucen, XIAO Shune, WEI Zairong, NIE Kaiyu, LIU Zhiyuan, CHANG Shusen, JIN Wenhu, CHEN Wei, ZHANG Fang. Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 69-73. doi: 10.7507/1002-1892.202310013 Copy

1.	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.
2.	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.
3.	劉建書, 唐舉玉, 劉鳴江, 等. 背闊肌皮瓣修復四肢軟組織缺損的臨床應用. 吉林醫學, 2010, 31(9): 1160-1161.
4.	Branford OA, Kelemen N, Hartmann CEA, 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): 737-748.
5.	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.
6.	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.
7.	程宏宇, 王光軍, 王晶, 等. 游離背闊肌肌皮瓣修復電燒傷后頭部巨大缺損六例. 中華燒傷雜志, 2017, 33(8): 504-506.
8.	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.
9.	周健輝, 石惠文, 冷樹立, 等. 踇趾腓側折疊皮瓣修復拇指全指腹缺損. 中華手外科雜志, 2013, 39(2): 176-178.
10.	王增濤, 朱磊, 吳昊, 等. 足背分裂皮瓣在類圓形皮膚缺損修復中的應用. 中華顯微外科雜志, 2008, 31(2): 92-94, 插5.
11.	胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
12.	Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg, 1976, 58(6): 680-688.
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. 中國修復重建外科雜志, 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): 469-470.
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. 中華顯微外科雜志, 2011, 34(6): 494-495.
17.	肖海濤, 王懷勝, 劉曉雪, 等. 游離背闊肌肌瓣結合中厚皮移植修復大面積全層頭皮缺損九例. 中華燒傷雜志, 2015, 31(4): 310-311.
18.	王立宇, 崔英健, 范元軍, 等. 背闊肌皮瓣的臨床解剖學研究. 解剖學研究, 2014, 36(3): 164-167.
19.	馬超, 陶然, 舒軍, 等. 背闊肌肌皮瓣修復較大軟組織缺損的方法及供區繼發創面的處理. 中華燒傷雜志, 2020, 36(12): 1199-1203.
20.	Dancey AL, Cheema M, Thomas SS. A prospective randomized trial of the efficacy of marginal quilting 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.
21.	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.
22.	Schwabegger AH, Harpf C, Rainer C. 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.

1. 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.
2. 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.
3. 劉建書, 唐舉玉, 劉鳴江, 等. 背闊肌皮瓣修復四肢軟組織缺損的臨床應用. 吉林醫學, 2010, 31(9): 1160-1161.
4. Branford OA, Kelemen N, Hartmann CEA, 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): 737-748.
5. 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.
6. 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.
7. 程宏宇, 王光軍, 王晶, 等. 游離背闊肌肌皮瓣修復電燒傷后頭部巨大缺損六例. 中華燒傷雜志, 2017, 33(8): 504-506.
8. 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.
9. 周健輝, 石惠文, 冷樹立, 等. 踇趾腓側折疊皮瓣修復拇指全指腹缺損. 中華手外科雜志, 2013, 39(2): 176-178.
10. 王增濤, 朱磊, 吳昊, 等. 足背分裂皮瓣在類圓形皮膚缺損修復中的應用. 中華顯微外科雜志, 2008, 31(2): 92-94, 插5.
11. 胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
12. Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg, 1976, 58(6): 680-688.
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. 中國修復重建外科雜志, 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): 469-470.
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. 中華顯微外科雜志, 2011, 34(6): 494-495.
17. 肖海濤, 王懷勝, 劉曉雪, 等. 游離背闊肌肌瓣結合中厚皮移植修復大面積全層頭皮缺損九例. 中華燒傷雜志, 2015, 31(4): 310-311.
18. 王立宇, 崔英健, 范元軍, 等. 背闊肌皮瓣的臨床解剖學研究. 解剖學研究, 2014, 36(3): 164-167.
19. 馬超, 陶然, 舒軍, 等. 背闊肌肌皮瓣修復較大軟組織缺損的方法及供區繼發創面的處理. 中華燒傷雜志, 2020, 36(12): 1199-1203.
20. Dancey AL, Cheema M, Thomas SS. A prospective randomized trial of the efficacy of marginal quilting 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.
21. 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.
22. Schwabegger AH, Harpf C, Rainer C. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back

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