Free Latismus Dorsi Muscle Flap with a Flow-Through Technique for Lower Limb Salvage

Wael M. Ayad; Abdelnaser Hamdi Mohammed; Hany M. Ismail; Mohamed Osama Ouf; Amr M. Elbatawy

doi:10.12790/ahm.2019.24.2.177

Journal List > Arch Hand Microsurg > v.24(2) > 1125378

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Ayad, Mohammed, Ismail, Ouf, and Elbatawy: Free Latismus Dorsi Muscle Flap with a Flow-Through Technique for Lower Limb Salvage

Original Article

Arch Hand Microsurg 2019;24(2):177-182.

Published online: 5 January 2019

DOI: https://doi.org/10.12790/ahm.2019.24.2.177

Free Latismus Dorsi Muscle Flap with a Flow-Through Technique for Lower Limb Salvage

Wael M. Ayad, Abdelnaser Hamdi Mohammed, Hany M. Ismail, Mohamed Osama Ouf, Amr M. Elbatawy

Department of Plastic and Burn Surgery, Al Azhar University, Cairo, Egypt

Corresponding author: Amr M. Elbatawy Department of Plastic and Burn Surgery, Al Azhar University, 148 Elsad st., Cairo 11511, Egypt TEL: +20-1113033384, FAX: +20-25326791, E-mail: Amrelbatawy@azhar.edu.eg, ORCID: https://orcid.org/0000-0003-2562-7291

Received 25 July 20186 January 2019 Accepted 12 March 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

The lower limb injuries still one of the devastating problems in surgical practice. Complex defects may affect one major vessel that supplies the distal portion of the leg and foot. The use of the flow-through technique is a very useful tool for sure vascularization of the flap and revascularization of the distal limb at the same time. The aim of this study was to evaluate the advantages of the use of the flow-through technique for lower limb reconstruction.

Methods:

This retrospective study was including 15 patients complaining of posttraumatic leg and/or foot defects. Free latissimus muscle transfer with the flow-through technique was done for lower limb reconstruction. The subscapular artery was anastomosed to the proximal segment of the limb vessel and the circumflex scapular artery anastomosed to the distal segment of the limb vessel. Follow-up was for six months.

Results:

Patients were followed for 6 months. All flaps were survived and there were no anastomotic complications.

Conclusion:

The use of the flow-through technique is a very useful tool for vascularization of the flap and revascularization of the distal limb at the same time.

Keywords: Free tissue transfer flaps, Lower limb, Reconstructive surgical procedure, Microsurgical free flap

REFERENCES

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Fig. 1.

A case of free tissue transfer for left leg. A patient who was reconstructed by chimeric flap flow-through technique for coverage of posttraumatic soft tissue loss of the lower third of the left leg. (A) Preoperative photograph. Demonstrates soft tissue loss of the lower third of the leg with the exposed fibula. (B) Debridement and excision of all devitalized tissues. (C) Design of the chimeric myocutaneuos flap. (D) Chimeric flap after separation.

Fig. 2.

A case of free tissue transfer for left leg. A patient who was reconstructed by chimeric flap flow-through technique for coverage of posttraumatic soft tissue loss of the lower third of the left leg. (A) Anterior tibial vessels prepa-ration for anastomosis. (B) After anastomosis. (C) Diagram showing the vessels were anastomosed. (D) A photograph at follow-up on postoperative year 2.

Fig. 3.

A case of free latissimus myocutaneuos flap transfer. A male patient was reconstructed by free latissimus myocutaneuos flap transfer for salvage of the left leg. (A) Preoperative photograph. (B) Preoperative marking of the flap. (C) Latissimus myocutaneuos flap after separation. (D) An immediate postoperative photograph.

Fig. 4.

A case of heel reconstruction. A patient with unstable, adherent scar overlying the right heel. The patient was reconstructed by free latissimus myocutaneuos flap transfer. (A) Preoperative photograph. (B) A photograph at follow-up on postoperative year 1.

Table 1.

Patient's data

Case No.	Age (yr)	Sex	Defect	Flap size (cm)	Recipient vessels	Complications	2 yr procedures
1	40	Female	Lower 1/3 of leg and planter surface of foot	20×30	Posterior tibial vessels	-	-
2	36	Male	Lower 1/3 of leg and planter surface of foot	1st flap: 15×202nd flap: 14×18	1st stage: anterior tibial vessels 2nd stage: posterior tibial vessels	-	-
3	26	Male	Lower 1/3 of leg	16×20	Posterior tibial vessels	-	-
4	40	Female	Dorsum of foot	15×10	Anterior tibial vessels	-	-
5	33	Male	Medial aspect of foot	15×12	Posterior tibial vessels	-	-
6	25	Male	Dorsum of foot	14×16	Anterior tibial vessels	-	-
7	42	Male	Lower third of leg	19×22	Posterior tibial vessels	-	Debulking
8	38	Male	Lower part of leg	25×15	Posterior tibial vessels	Heamatoma	Evacuation
9	40	Male	Foot	12×18	Posterior tibial vessels	-	-
10	36	Male	Foot	20×25	Posterior tibial vessels	Partial necrosis	Debridment
11	27	Male	Foot	14×16	Posterior tibial vessels	Partial necrosis	Debridment
12	30	Male	Foot	12×15	Posterior tibial vessels	-	-
13	32	Male	Foot	13×15	Anterior tibial vessels	-	-
14	50	Male	Foot	13×15	Posterior tibial vessels	Partial necrosis	Debridment
15	41	Male	Foot	14×15	Posterior tibial vessels	-	-

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