Application of latissimus dorsi flap and thoracodorsal artery perforator flap in different wounds / 中华整形外科杂志

Objective@#To explore the application and choice of latissimus dorsi musculocutaneous flap and thoracodorsal artery perforator flap in different wound repair.@*Methods@#From March 2012 to February 2018, 8 cases of different wounds were repaired with island latissimus dorsi myocutaneous flap pedicled with dorsal thoracic artery, free latissimus dorsi myocutaneous flap, or thoracodorsal artery perforator flap combined with scapular flap. The patients includes 4 cases of trauma, 2 cases of tumor and 2 cases of osteomyelitis. Among them, 5 cases received pedicled grafting, 2 cases had anastomotic vascular free grafting combined with antibiotic bone cement chain bead, 1 case had thoracodorsal artery perforator flap combined with scapular flap.@*Results@#All 9 flaps of 8 patients survived. The size of the flaps ranged from 22.0 cm×7.5 cm to 28.0 cm×21.0 cm. All the donor and recipient areas healed well. After 2 months to 2 years follow up, all flaps have good blood supply, and the limbs′ function was normal. The appearance of flaps were satisfactory, with fully treated osteomyelitis, and no recurrence of the tumor was observed.@*Conclusions@#According to wound characteristics, selective application of thoracodorsal artery perforator flap, pedicled or free latissimus dorsi myocutaneous flap is effective for the repair of muscle, skin and soft tissue defects, as well as osteomyelitis, after tumor resection.

Use of Abnobaviscum to treat refractory seroma after breast reconstruction with a latissimus dorsi flap: A case report

In recent years, there has been a notable increase in the rate of refractory donor site seroma, defined as seroma that persists for at least 3 months postoperatively, as the number of breast reconstructions using a latissimus dorsi (LD) musculocutaneous flap has increased. Various factors have been proposed to be related, including smoking, obesity, flap mass, and body weight, and several studies have been conducted to explore treatment methods. Typically, surgical treatment, such as capsulectomy, has been considered for refractory seroma, but in this case report, we describe positive outcomes achieved by using Abnobaviscum to treat three female patients who developed a donor site seroma at least 3 months after breast reconstruction using an LD flap.

Optimized reconstruction of oral and maxillofacial defects with common soft-tissue free flaps / 口腔疾病防治

@#Severe tissue defects in the oral and maxillofacial region are commonly caused by tumor resection and trauma and can impair physiological function and aesthetics in patients. Applying a soft-tissue free flap transfer may avoid exposing important blood vessels and nerves and restore basic anatomical structures and facial features. However, the outcomes of soft-tissue free flap transfer have tended to be unsatisfactory because of the exquisite anatomical structure and complicated functions of the oral and maxillofacial region. Therefore, it is clinically important to choose a proper reconstructive method based on specific tissue defects and to optimize the processes involved in the designing and harvesting of soft-tissue free flaps. In this review, we summarize the application of soft-tissue free flaps in oral and maxillofacial defects and strategies for optimizing the quality of tissue reconstruction.

Comparison of the therapeutic effect between immediate breast re-construction with latissimus dorsi musculocutaneous flap after modified radical mastectomy and conventional modified radical operation on breast cancer / 中国肿瘤临床

Objective:To compare the therapeutic effect of immediate breast reconstruction using latissimus dorsi musculocutane-ous flap after modified radical mastectomy with the conventional modified radical surgery of breast cancer. Methods:A retrospec-tive analysis of 224 female patients with Stage 0 to IIIA breast cancer was conducted. The patients were admitted to the Department of Breast Surgery of Liuzhou People's Hospital between November 2009 and July 2012. The cases were divided into two groups accord-ing to different surgical options:immediate breast reconstruction (IBR) and modified radical surgery of the breast (MRSB). After con-trastive analyses of the postoperative complications, cosmetic results, quality of life, local failure rate, distant metastases and mortality rates between the two groups, the therapeutic efficiency of the two surgeries was evaluated. Results:No statistical differences were ob-served in the postoperative complications between the two groups, such as hydrops, skin flap necrosis, limb exercise and shoulder joint motion, drainage time, and starting time of adjuvant therapy (P>0.05). The patients in the IBR group had a better quality of life than those in the MRSB group (P0.05). Conclusion:Compared with the tradi-tional MRSB group, the option of IBR after modified radical mastectomy not only achieves similar therapeutic outcomes but also pres-ents advantages such as better aesthetic effect of the reconstructed breast, easy surgical procedures, high safety, improvement of the breast contour outline, and improved quality of life after operation. Therefore, IBR is a safe and available therapeutic method for pa-tients with early breast cancer.

Latissimus dorsi musculocutaneous flap for repairing severe soft tissue defect of the elbow / 中国医师进修杂志

Objective To explore the effect of latissimus dorsi musculocutaneous flap for repairing severe soft tissue defect of the elbow.Methods Seventeen patients with severe soft tissue defect of the elbow were repaired by latissimus dorsi musculocutaneous flap.Ten patients were performed transfer of skin flap for functional reconstruction,9 patients reconstructed elbow flexion,and 1 patient reconstructed elbow extension.Seven patients' tissue defect were repaired by cover type musculocutaneous flap,and the areas of these flaps ranged from 6 cm × 10 cm-12 cm × 27 cm.Results All the musculocutaneous flaps kept alive.After an average postoperative follow-up for 12-40(22.0 ± 9.6) months,the color and luster of the flaps were satisfying.There were no scar contracture of the flap and no bulkiness of the elbow.Ten patients performed transfer of skin flap for functional reconstruction,and the range of motion was 100°-140° of flexion and-20°-0° of extension.Muscle power was M3-M5.Hand function was near normal.Conclusion Latissimus dorsi musculocutaneous flap is an ideal surgical method to repair the severe soft tissue defect of the elbow.

V-Y Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Radiation-induced Skin Injuries on the Back

PURPOSE: Cardiac radiofrequency catheter ablation procedures using fluoroscopy were performed for the treatment of supraventricular and selected ventricular tachyarrhythmia. Fluoroscopy is used to localize the position of the intracardiac catheter. Fluoroscopically- guided procedures often involve high radiation doses to patient's skin, but the incidence of serious radiation injuries in these patients is rare. We reported two cases of severe postradiation skin injury on the back treated with the V-Y latissimus dorsi musculocutaneous flap. METHODS: These two patients underwent radiofrequency catheter ablation under the diagnosis of Woff Parkinson White syndrome(WPW syndrome). They had radiation- induced skin injuries on the subscapular area and these lesions represented chronic ulceration, surrounding induration, hardness, and dyspigmentation. We treated these lesions with complete excision and coverage with V-Y latissimus dorsi musculocutaneous flap. RESULTS: These two patients had no recurrence and no special complications during 20 months and 12 months follow-up periods and were satisfied aesthetically and functionally. CONCLUSION: V-Y latissimus dorsi musculocutaneous flap obtained better results functionally and aesthetically compared with conservative management and skin graft in severe radiation-induced skin injuries after cardiac radiofrequency catheter ablation procedure.

The three Dimensional Facial Reconstruction of Maxillary Defects using Latissimus Dorsi Musculocutaneous Free Flaps

Surgical reconstruction of malignancies of the head and neck often leave large defects that demands reconstruction. A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. This can leave a large anatomical defect that invades surrounding anatomical boundaries including the oral cavity, nasal cavity, orbital cavity, soft tissues of the face, and anterior skull base. Surgical repair of maxillary defects has been widely reported. Skin graft, local and regional flaps such as local mucosal flaps, buccal fat pad, temporalis muscle and pectoralis major muscle pedicled flaps, and free tissue transfer can be used depending largely on the size of the defect. We performed facial reconstruction using a latissimus dorsi musculocutaneous free flap for covering large defects that involved exposed orbit, nasal, and oral cavities in seven patients after total maxillectomy for maxillary cancer. One case was immediate reconstruction and the others were secondary reconstruction during the follow up period after primary cancer surgery. The skin of the latissimus dorsi musculocutaneous flap was pliable and its texture was similar to that of the face. The muscle bulkiness was sufficient to reconstruct the soft tissue of the intraoral and nasal lining and external skin deficits. All flaps had survived and serious complications were not developed. None of the patients need secondary defatting procedures later for the excessive bulkiness, but oronasal fistulas developed in two patients and one patient had cicatrical ectropion of lower eyelid. All donor defects were closed primarily and there has been no noticeable residual functional problems or discomfort in the shoulder area.