From March 1991 to October 1993, 6 the latissimus dorsi M. was transferred to reconstruct the flexor of the elbow following the injury of brachial plexus in 12 cases (8 males and 4 females). The average age was 31-year-old (6to 45-year-old). The patients were followed up for six months to two years. All of musculocutaneous flaps were survived. The contour of the upper arm was satisfactory. In 8 cases, the muscle strength was more than grade 4 and the active motion of the elbow was 135 degrees in flexion and 10 degrees in extension. The elbow could lift the load of l0kg. In 2 cases, the muscle strength was grade 4 and the active movement was 25 degrees in flexion and 25 degrees in extension. On 90 degrees flexion, the elbow could lift the load of 3kg. In 2 cases, the muscle strength was grade 3 and the active movement of elbow was 100 degrees in flexion 25 degrees in extension. Following the irreversible injury of the brachial plexus, the atrophy of the muscles was obvious. After the transfer of musculocutaneous flap, the circumference of the arm was increased while the tenseness of the skin was decreased. This faciliated the movement of the transferred muscle, improved the appearance of the upper limb and was convenient to observe the blood supply of the flap. When the brachial plexus was injuried at the root level, the latissimus dorsi M. was atrophied, after transfer of the nerve to the muscle, the function of the muscle recovered, then the tranferred muscle could be transferred to reconstruct the flexor of the elbow.
From 1987, in 4 cases having muscle damage associated with extensive skin defeet, the repair was carried out by anastomosing the neurovascular pedicle of the free latissimus dorsi myocutaneous graft with the host. The patients were followed up from 6 months to 3 years. The muscle power of the injured part following repair had returned to about 4 degrees, and the external appearance and the function were satisfactory. The advantages and disadvantages of this operation, the preparation of the recipient area and the management of the tendon were discussed.
Form April 1991 to August 1994, ten cases of extensive soft tissue injury of the extremities with bone and tendons exposed were treated by emergency transfer of latissimus dorsi myocutaneous flaps. The types of the myocutaneous flap were as follows: with vascular pedicle in 1 case, free latissimus dorsi myocutaneous flap in 8 cases,and transfer of combined bilateral latissimus dorsi myocutaneous flaps in 1 case. There were 8 males and 2 females with the ages ranging from 7 to 44 years (an average of 24.4 years). The operations were all performed within 6 hours after trauma except in 1 case, due to its delayed arrival to our hospital, the operation was carried out 14 days after trauma. The results were as follows: total survival of the flap in 6 cases, necrosis of the distal portion of the skin of the flap in 3 cases and necrosis of a greater portion of the skin in one case who had been subjected the transfer of combined bilateral latissimus dorsi myocutaneous flap. but the deep muscle layerwas intact. However, the result was encouraging. The operative technique and the advantages of emergency coverage of the wound were discussed.
Objective To explore the clinical effect of latissimus dorsi musculocutaneous flap with a few muscle in repairing the soft tissue defect of lower limbs. Methods From June 2000 to December 2006, 8 patients with soft tissue defects of lower limbs were repaired with the latissimus dorsi musculocutaneous flaps. There were 6 males and 2 females, aged from 2569 years. The locations were heel in 3 cases, dorsum pedis in 2 cases, anticnemion in 2 cases, and the right leg (squamous carcinoma) in 1 case. The area of soft defect ranged from 10 cm×7 cm～18 cm×12 cm. The flap in size ranged from 15 cm×8 cm to 22 cm×15 cm. Results Of all the flaps,6 survived,1 had vascular necrosis 2 hours after operation and survived by skin grafts, 1 had delayed healing because of infection. The wound and donor site achieved primary healing. The followup for 3 to 12 months revealed that all the flaps had a good appearance. The function of donor site was as normal. Conclusion It is an ideal method to repair the softtissue defect of lower limbs with latissimus dorsi musculocutaneous flap.
ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.
Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S1 in 2 cases, S2 in 6 cases, S3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
Objective To evaluate the feasibil ity and cl inical significance of the computed tomography angiography (CTA) for the latissimus dorsi muscle (LDM) flap transplantation. Methods From September 2007 to August 2008, 3 cases of soft tissue defects in l imbs were treated with LDM flap transplantation. Three patients included 2 males and 1 female whowere 23 to 42 years old. All of soft tissue defects were caused by trauma. The locations were the forearm in 2 cases and the leg in 1 case. The area of defect was 17 cm × 8 cm-20 cm × 10 cm. All cases received CTA to observe the distribution and anastomosis of thoracodorsal artery. Subsequently, three-dimensional computer reconstruction were carried out to display the stereoscopic structure of the LDM flap and to design the LDM flap before operation. Results The anatomy characteristic of LDM flap can be displayed accurately by the three-dimensional reconstruction model. The distribution of thoracodorsal artery in 3 cases of flaps was in concordance with preoperative design completely. All the flaps were excised successfully, the area of the flap was 19 cm × 10 cm-22 cm × 12 cm. All the transferred flaps survived completely. All cases were followed up from 4 months to 12 months. The color and texture of the flaps were good. Conclusion The three-dimensional reconstructive images can provide visible, stereoscopic and dynamic anatomy for cl inical appl ication of LDM flap. The digitized three-dimensional reconstructive models of LDM flap structures can be appl ied in cl inical training and pre-operative design.
Transplantation of composite latissimus dorsi myocutaneous flap and vascularized fibula was performed primarily to repair the tibial defects in 12 cases and radial defects in 2 cases, both of which were associated with large-sized skin defects. The peroneal artery and vein of the fibula were anastomosed to the circumflex scapular artery and vein of the myocutaneous flap, the subscapular artery and vein, as the common vascular pedicle of the two transplants, are anastomosed to the nutrient vessels in the recipient site. Cross-bridge vascular anastomosis was used in 13 cases . All of tfe transplanted tissues survived, Follow-up revealed a good growthof the transplanted flaps, solid union between the transplanted fibulas and the host bones, and the good functional recovery of the repaired extremities. The operative indication and technique were introduced, ahd the merit of the repair ahd reliability of the cross-bridge procedure were discussed.
OBJECTIVE: To investigate the feasibility of segmentation of latissimus dorsi on the basis of anatomy and electrophysiology. METHODS: Ten cadaveric latissimus dorsi was dissected according to the blood supply, nerve innervation. Electromyelogram (EMG) of latissimus dorsi of 13 healthy persons was recorded with superficial electrode plate in the motion of shoulder joint. The results of record were managed with statistic methods. Ten patients(including reconstruction of breast and repair of scar on elbow joint and on chest wall) were treated with the lateral inferior myocutaneous island flap. RESULTS: According to the medial and lateral vasculonervous branches, latissimus dorsi can be divided into the medial superior and lateral inferior segments. The clinical application of the segment achieved good results in reconstructing breast and in repairing scars on elbow and on chest wall. CONCLUSION: Latissimus dorsi can be divided into two segments and applied separately. The lateral inferior segment is more useful in shoulder motion.
Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.