Abdominal wall reconstruction with the free functional L-shaped latissimus dorsi flap: A case report.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
19
03
2023
received:
17
07
2022
accepted:
17
05
2023
medline:
19
9
2023
pubmed:
25
5
2023
entrez:
25
5
2023
Statut:
ppublish
Résumé
Extensive tridimensional defects of the abdominal wall are usually addressed with soft tissue flaps combined with meshes. In this scenario, the additional value of dynamic abdominal wall reconstruction with functional flaps has yet to be demonstrated. In this paper the authors describe for the first time a unique case of total abdominal wall reconstruction with the free functional L-shaped latissimus dorsi (LD) flap, designed to increase the surface area of skin flap coverage while minimizing donor site morbidity, highlighting technical tips and long-term outcomes. A 65-year-old patient underwent abdominal wall resection for a dermatofibrosarcoma protuberans, leaving her with a 23 × 15 cm full-thickness defect. After placing a mesh, a myo-cutaneous free LD Flap with an L-shaped configuration was planned. The flap was composed of Paddle A, designed vertically along the anterior margin of the muscle and Paddle B, designed over the inferior aspect of the LD muscle, extending obliquely from the midline and intersecting Paddle A laterally with a 60° angle. End-to-end anastomoses to the deep inferior epigastric artery and vein and thoracodorsal nerve coaptation to a sizeable intercostal nerve were performed. The LD muscle was sutured according to its native tension while the two skin islands allowed an almost complete resurfacing of the abdominal wall defect. Donor site was closed primarily. Post-operative course was uneventful. One year postoperatively, good abdominal contour was observed, with adequate abdominal tone at rest in laying and standing position. Muscle neurotization was confirmed with clinical examination showing voluntary contraction of the transplanted muscle and the patient reported very high functional outcomes at the hernia-related quality-of-life (HerQles) questionnaire. The free L-shaped LD flap represents an innovative solution to reconstruct extensive full-thickness defects of the abdominal wall while reducing donor site morbidity. Flap neurotization should be attempted whenever possible to improve functional outcomes of the procedure.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
617-621Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Aliotta, R. E., Gatherwright, J., Krpata, D., Rosenblatt, S., Rosen, M., & Gurunluoglu, R. (2019). Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life. Hernia, 23(2), 205-215. https://doi.org/10.1007/s10029-019-01916-w
Bodin, F., Dissaux, C., Romain, B., Rohr, S., Brigand, C., & Bruant-Rodier, C. (2017). Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection. Microsurgery, 37(1), 38-43. https://doi.org/10.1002/micr.22434
Brunetti, B., Morelli Coppola, M., Ciarrocchi, S., Salzillo, R., Tenna, S., & Persichetti, P. (2022). “Thou shalt not throw away a living thing”―Innovative use of perforator flaps in abdominal wall reconstruction. Plastic and Reconstructive Surgery, 150, 672-676. https://doi.org/10.1097/PRS.0000000000009450
Brunetti, B., Salzillo, R., Tenna, S., Cagli, B., Morelli Coppola, M., Petrucci, V., Camilloni, C., Zhang, Y. X., & Persichetti, P. (2022). Total autologous breast reconstruction with the Kiss Latissimus Dorsi Flap. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75, 3673-3682. https://doi.org/10.1016/j.bjps.2022.06.078
Liu, Z., Tang, X., Wang, D., Wei, Z., Jin, W., Deng, C., & Qi, J. (2017). Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 31(9), 1106-1110. https://doi.org/10.7507/1002-1892.201704047
Ninković, M., Kronberger, P., Harpf, C., Rumer, A., & Anderl, H. (1998). Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plastic and Reconstructive Surgery, 101(4), 971-978. https://doi.org/10.1097/00006534-199804040-00013
Vranckx, J. J., Stoel, A. M., Segers, K., & Nanhekhan, L. L. (2015 Jun). Dynamic reconstruction of complex abdominal wall defects with the pedicled innervated vastus lateralis and anterolateral thigh PIVA flap. Journal of Plastic, Reconstructive & Aesthetic Surgery, 68(6), 837-845. https://doi.org/10.1016/j.bjps.2015.03.009
Xiong, L., Guo, N., Gazyakan, E., Kneser, U., & Hirche, C. (2018). The anterolateral thigh flap with kiss technique for microsurgical reconstruction of oncological scalp defects. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(2), 273-276. https://doi.org/10.1016/j.bjps.2017.10.018
Yoshimatsu, H., Hayashi, A., Karakawa, R., & Yano, T. (2020). Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery, 40(6), 649-655. https://doi.org/10.1002/micr.30620
Zhang, Y. X., Hayakawa, T. J., Levin, L. S., Hallock, G. G., & Lazzeri, D. (2016). The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plastic and Reconstructive Surgery, 137(3), 1018-1030. https://doi.org/10.1097/01.prs.0000479971.99309.21