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Microsurgical reconstruction of extensive lower extremity defects with the conjoined parascapular and latissimus dorsi free flap
Author(s) -
Bigdeli Amir K.,
Thomas Benjamin,
Falkner Florian,
Radu Christian A.,
Gazyakan Emre,
Kneser Ulrich
Publication year - 2020
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30640
Subject(s) - medicine , surgery , thrombosis , free flap , venous thrombosis , microsurgery , latissimus dorsi muscle
Background Extensive lower extremity soft‐tissue defects pose a reconstructive challenge. We present our experience with the conjoined parascapular and latissimus dorsi (CPLD) free flap. Methods From October 2008 to October 2017, 69 patients (14 female, 55 male) with a mean age of 50 years (range: 16–79 years) underwent reconstruction of lower extremity defects with the CPLD free flap. Mean defect size was 24 × 36 cm (range: 14 × 20 to 45 × 80 cm). Results Mean latissimus dorsi (LD) flap size was 19 × 28 cm (range: 14 × 20 to 28 × 42 cm) and mean parascapular (PSC) flap size was 8 × 25 cm (range: 5 × 12 to 11 × 33 cm). Six patients (9%) experienced a total of eight microvascular complications: arterial thrombosis ( n = 1), venous thrombosis ( n = 6), combined arterial and venous thrombosis ( n = 1). The re‐exploration rate was 13%. Major complications of the donor‐site were seen in 9 patients (13%), of the flap in 13 patients (19%), and of both in 6 patients (9%). Fifteen patients experienced partial flap necrosis (22%). Three CPLD and one PSC flap were lost (5%). PSC flap length was a significant predictor of distal flap necrosis ( χ 2 (1) = 13.2, p = .004, OR = 1.343, 95% CI [1.098–1.642]). PSC flap width was a significant predictor of donor‐site revisions ( χ 2 (1) = 15.9, p = .010, OR = 4.745, 95% CI [1.584–14.213]). Arterio‐venous loops (AVLs) tended to increase the risk of microvascular thrombosis ( χ 2 (1) = 3.7, p = .08, OR = 4.1, 95% CI [0.9–18.7]). Conclusions The CPLD free flap is an extremely large and highly reliable flap, allowing one‐stage reconstruction of extensive lower extremity defects. It may overcome the need for multiple flaps in selected cases.