Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap for postoperative deep infection after spinal instrumentation / 中华创伤骨科杂志

Objective To explore a potentially effective treatment of postoperative deep infection after spinal instrumentation without removal of implants. Methods A total of 4 patients with postoperative deep infection after spinal instrumentation were treated at our hospital between January 2015 and May 2016. They were 2 men and 2 women, aged from 62 to 75 years (mean, 69.2 years). They were treated with ag-gressive surgical debridement under the guidance of methylene blue and negative pressure wound therapy. Reversed latissimus dorsi muscle flap was used to obturate the wound when the bacterial culture of the wound was negative and the relevant inflammatory indicators returned to normal. Negative pressure treatment con-tinued over the closed incision. Results The devices for negative pressure wound therapy were removed in the 4 patients one week after surgery. All the wounds were healed well by first intention 2 weeks after surgery without removal of their implants. The patients were discharged after their examinations for blood routine, CRP, ESR and PCT turned to be normal. Follow-ups for more than one year revealed no re-infection, implants loosening or other adverse effects. Conclusions Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap is a new attempt to treat postoperative deep infection after spinal instru-mentation without implant removal. It may increase the rate of implants reserved, accelerate wound healing and raise the curative rate of deep infection.

A Case of Mycotic Aneurysm Repaired by Wrapping the Pedicled Latissimus Dorsi Muscle Flap around the Artificial Graft / 日本心臓血管外科学会雑誌

A 69-year-old man with histories of cardiac and abdominal operations was hospitalized in another hospital due to brain contusion. Due to hemorrhage from the distal descending thoracic aorta, he was transferred to our hospital. After a diagnosis rupture of mycotic aneurysm an urgent operation was performed. The aneurysm was replaced by an <i>in situ </i>graft. For infection control, the graft was wrapped tightly by a pedicled latissimus dorsi muscle flap. Postoperatively, local infection of the muscle-dissected cavity continued. Although his life was ultimately not saved, he was able to live a comfortable hospital life with some activity for 8 months.

Breast reconstruction using extended latissimus dorsi muscle flap

The latissimus dorsi myocutaneous flap was one of the first methods of breast reconstruction described. However, a standard latissimus dorsi flap alone often does not provide sufficient volume for breast reconstruction and has been performed with an implant to achieve adequate breast volume. The design of an extended latissimus dorsi flap has evolved to include the parascapular and scapular fat-fascia extension in addition to lumbar fat for additional volume. The main advantage of the extended latissimus dorsi flap is that it can provide autologous tissue to the reconstructed breast without an implant and with an acceptable donor site contour and scar. The extended latissimus dorsi flap elevation is of dissection in plane just beneath the fascia superficialis, leaving the deep fat attached to the surface of the muscle. The fat left attached to the surface of the muscle is well vascularized by the perforators coming from the muscle itself. Division of the humeral attachment of the muscle is performed for an adequate excursion of the flap. Denervation of the thoracodorsal nerve is recommended for preventing postoperative involuntary muscle contraction. Patients should be warned of the potential donor site seroma. The extended latissimus dorsi flap proved to be a reliable option for totally autologous breast reconstruction in selected patients. The flap is reliable, and the procedure is technically straightforward and consistent.

Management of Intractable Cerebrospinal Fluid Collection after Cerebellar Tumor Resection: A Case Report

PURPOSE: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. METHODS: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. RESULTS: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. CONCLUSION: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura.

A Retrospective Study for Method and Timing of Reconstruction Using Free Latissimus Dorsi Muscle Flap at Foot in Electrical Burn Patients

High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.

Modified radical mastectomy-stage Ⅰ expansion of latissimus dorsi muscle flap breast reconstruction / 中国癌症杂志

Background and purpose:Physical and psychological trauma has been a challenge for both clinician and patients with breast cancer after modified radical mastectomy,and now more and more patients have begun to accept breast reconstruction,especially Ⅰ stage reconstruction after surgery.The aim of our study was to investigate a breast reconstruction procedure that can not only achieve radical tumor excision but also retain the aesthetic appearance of breast.Methods:15 patients from January 2006 to April 2007 were enrolled with early stage breast cancer have received surgical treatment with conservation of breast skin,breast tissue excision and axillary lymph nodes;latissimus dorsi muscle flap has been used for breast reconstruction.Results:The results of the 15 cases:excellent in 11 cases(83.3%),good in four cases(16.7%).Conclusions:Immediate breast reconstruction after radical mastectomy with conservation of skin has shown good results in terms of aesthetic appearance of breast,this procedure has been proved to be a safe and feasible method of treatment for the patients with early stage breast cancer.