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Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer
Author(s) -
He Jiqiang,
Qing Liming,
Wu Panfeng,
Zhou Zhengbing,
Yu Fang,
Tang Juyu
Publication year - 2021
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.30754
Subject(s) - medicine , surgery , ankle , perforator flaps , thigh , soft tissue , plastic surgery , posterior tibial artery , latissimus dorsi muscle , artery
Background Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow‐through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft‐tissue defects is described. Methods From January 2012 to September 2018, 12 patients (six men and six women) aged 6–37 years, sustained injuries in road traffic accidents with large soft‐tissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25 × 20 cm 2 to 36 × 25 cm 2 . All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow‐through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap. Results The size of the flow‐through ALT perforator flaps ranged from 13.5 × 6.5 cm 2 to 31 × 8.5 cm 2 . The size of the LD musculocutaneous skin paddle ranged from 25 × 6 cm 2 to 34 × 7 cm 2 , and that of the muscle paddle ranged from 13 × 3.5 cm 2 to 30 × 11 cm 2 . One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re‐exploration and thrombectomy. No other complications were observed postoperatively. The mean follow‐up period was 26.8 months. All patients were able to ambulate independently at the end of the follow‐up period. Conclusions The combined transfer of the LD musculocutaneous flap and flow‐through ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft‐tissue defects.