초록
Latissimus dorsi muscle flap is a commonly used reconstructive method on chest wall reconstruction. But meeting patient with absence of latissimus dorsi muscle on intra-operatively is very rare and embarrassing experience. A 73-year-old woman visited our clinic with radiation induced chronic ulceration on the right chest. In the presented case, the patient had received modified radical mastectomy with radiation therapy 36 years ago and lymphatic edema of the upper extrem-ity lasting for 30 years. The ulceration was developed 6 weeks ago and accompanied by profound erythema and abscess pocket. The presence of right thoracodorsal artery in the computed tomography taken before surgery was confirmed and we planned to reconstruct the defect using latissimus dorsi muscle flap. When the authors dissected the skin paddle to elevate the flap, we found that there was no latissimus dorsi muscle. So, we decided to cover the defect by free style perforator flaps. We describe our experience of reconstructing radiation induced chest wall ulceration with intercostal and thoracodorsal artery perforator flaps on latissimus dorsi muscle absence patient. We recommend that the presence of latissimus dorsi muscle be confirmed by imaging before surgery if the patient has a long history of previous breast cancer surgery or lymphatic edema.
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Fig.1.
Pre-operative view. A 73-year-old woman with radiation induced chronic ulceration on the right upper chest.
![ahm-23-110f1.tif](/upload/SynapseXML/1149ahm/thumb/ahm-23-110f1.gif)
Fig.2.
Histologic findings. (A) Granulation tissues (H&E stain, ×200). (B) Ossification with chronic inflammation (H&E stain, ×200). H&E: hematoxylin and eosin.
![ahm-23-110f2.tif](/upload/SynapseXML/1149ahm/thumb/ahm-23-110f2.gif)
Fig.3.
(A) Pre-operative design of latissimus dorsi flap. (B) Intra-operative view; absence of latissimus dorsi muscle. (C) 1: intercostal artery perforator flap; which was original skin paddle of LD flap. 2: thoracodorsal artery perforator flap; which was used to cover the chest ulcer. (D) Immediate postoperative view; after advancement of intercostal artery perforator flap and transposition of thoracodorsal artery perforator flap. Immediate postoperative view; 1: advanced intercostal artery perforator flap, 2: transposed thoracodorsal artery perforator flap.
![ahm-23-110f3.tif](/upload/SynapseXML/1149ahm/thumb/ahm-23-110f3.gif)