Reconstruction of a lumbosacral defect using free latissimus dorsi flap with arteriovenous‐loop: impact of preserving serratus branch temporarily

Dear Editors, In comparison with other regions of the trunk, defects located in the lumbosacral region are rare (1). Various flaps such as local or regional have been designed to reconstruct the defects in this area (2). There are some difficulties in reconstruction arising from the quality of the surrounding tissue, and hence free flaps such as latissimus dorsi muscle flap may be a good option for reconstructing these defects. Free tissue transfer for coverage of complex wounds in the lumbosacral region can be limited by the lack of adequate recipient vessels. Suitable vessels may be at a considerable distance from the defect to be reconstructed in these situations and long vein grafts are needed for the pedicles to reach the recipient vessels, which reportedly increases the failure rate (3). In an attempt to reduce the complication rate, vein grafts and arteriovenous loops (AVLs) have been described for complex cases of free flap transfer in various body regions (4–6). In this article, we present a case with a large lumbosacral defect reconstructed with free latissimus dorsi flap (LDF) with an AVL and lesser ischaemia time while preserving the serratus branch of thoracodorsal vessels during loop maturation.