Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian , ZHENG Yucen , XIAO Shune ,  WEI Zairong , NIE Kaiyu , LIU Zhiyuan , CHANG Shusen , JIN Wenhu , CHEN Wei , ZHANG Fang

Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Folding; latissimus dorsi; myocutaneous flap; wound repair

DOI：

10.7507/1002-1892.202310013

Video：

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Objective To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back. Methods Between August 2018 and January 2023, the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients. There were 5 males and 3 females with the age ranged from 21 to 56 years (mean, 35.4 years). Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases. The causes of injury were chronic infection of skin and bone exposure in 2 cases, secondary wound after extensive resection of skin and soft tissue tumor in 4 cases, and wound formation caused by traffic accident in 2 cases. Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm. The disease duration ranged from 12 days to 1 year (median, 6.6 months). A pedicled latissimus dorsi myocutaneous flap was designed and harvested. The flap was divided into A/B flap and then were folded to repair the wound, with the donor area of the flap being pulled and sutured in one stage. Results All 7 flaps survived, with primary wound healing. One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change. The incisions of all donor sites healed by first intention. All patients were followed up 6 months to 4 years (mean, 24.7 months). The skin flap has a good appearance with no swelling in the pedicle. At last follow-up, 6 patients had no significant difference in bilateral shoulder joint motion, and 2 patients had a slight decrease in abduction range of motion compared with the healthy side. The patients’ daily life were not affected, and linear scar was left in the donor site. Conclusion The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation, less damage to the donor site, and quick recovery after operation.

Citation： ZHOU Jian, ZHENG Yucen, XIAO Shune, WEI Zairong, NIE Kaiyu, LIU Zhiyuan, CHANG Shusen, JIN Wenhu, CHEN Wei, ZHANG Fang. Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 69-73. doi: 10.7507/1002-1892.202310013 Copy

1.	李钢, 李小兵, 刘子健, 等. 背阔肌肌皮瓣修复肩部皮肤及三角肌缺损十例. 中华烧伤杂志, 2014, 30(4): 370-372.
2.	吕春柳, 李赞, 周晓, 等. 带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
3.	刘建书, 唐举玉, 刘鸣江, 等. 背阔肌皮瓣修复四肢软组织缺损的临床应用. 吉林医学, 2010, 31(9): 1160-1161.
4.	Branford OA, Kelemen N, Hartmann CEA, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5.	赵茹, 乔群, 柳成, 等. 背阔肌分区的解剖及临床应用. 中国修复重建外科杂志, 2003, 17(1): 38-40.
6.	沈余明, 马春旭, 胡骁骅, 等. 膝关节周围严重皮肤软组织缺损的组织瓣修复策略. 中华烧伤杂志, 2015, 31(5): 331-336.
7.	程宏宇, 王光军, 王晶, 等. 游离背阔肌肌皮瓣修复电烧伤后头部巨大缺损六例. 中华烧伤杂志, 2017, 33(8): 504-506.
8.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
9.	周健辉, 石惠文, 冷树立, 等. 踇趾腓侧折叠皮瓣修复拇指全指腹缺损. 中华手外科杂志, 2013, 39(2): 176-178.
10.	王增涛, 朱磊, 吴昊, 等. 足背分裂皮瓣在类圆形皮肤缺损修复中的应用. 中华显微外科杂志, 2008, 31(2): 92-94, 插5.
11.	胡涛涛, 常树森, 魏在荣, 等. 改良三纵五横法在股前外侧穿支皮瓣修复术前穿支定位中的应用研究. 中国修复重建外科杂志, 2021, 35(8): 1027-1032.
12.	Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg, 1976, 58(6): 680-688.
13.	梁尊鸿, 潘云川, 林志琥. 带蒂背阔肌肌皮瓣早期修复颈部电烧伤深度创面. 组织工程与重建外科杂志, 2016, 12(5): 297-299.
14.	唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科杂志, 2006, 20(11): 1087-1089.
15.	胡祖良, 张元海, 倪良方, 等. 带蒂背阔肌皮瓣转移修复Ⅳ度烧伤创面. 浙江临床医学, 2016, 18(3): 469-470.
16.	韦平欧, 谭海涛, 江建中, 等. 背阔肌皮瓣移植重建屈肘屈指功能11例. 中华显微外科杂志, 2011, 34(6): 494-495.
17.	肖海涛, 王怀胜, 刘晓雪, 等. 游离背阔肌肌瓣结合中厚皮移植修复大面积全层头皮缺损九例. 中华烧伤杂志, 2015, 31(4): 310-311.
18.	王立宇, 崔英健, 范元军, 等. 背阔肌皮瓣的临床解剖学研究. 解剖学研究, 2014, 36(3): 164-167.
19.	马超, 陶然, 舒军, 等. 背阔肌肌皮瓣修复较大软组织缺损的方法及供区继发创面的处理. 中华烧伤杂志, 2020, 36(12): 1199-1203.
20.	Dancey AL, Cheema M, Thomas SS. A prospective randomized trial of the efficacy of marginal quilting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
21.	Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
22.	Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.

1. 李钢, 李小兵, 刘子健, 等. 背阔肌肌皮瓣修复肩部皮肤及三角肌缺损十例. 中华烧伤杂志, 2014, 30(4): 370-372.
2. 吕春柳, 李赞, 周晓, 等. 带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
3. 刘建书, 唐举玉, 刘鸣江, 等. 背阔肌皮瓣修复四肢软组织缺损的临床应用. 吉林医学, 2010, 31(9): 1160-1161.
4. Branford OA, Kelemen N, Hartmann CEA, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5. 赵茹, 乔群, 柳成, 等. 背阔肌分区的解剖及临床应用. 中国修复重建外科杂志, 2003, 17(1): 38-40.
6. 沈余明, 马春旭, 胡骁骅, 等. 膝关节周围严重皮肤软组织缺损的组织瓣修复策略. 中华烧伤杂志, 2015, 31(5): 331-336.
7. 程宏宇, 王光军, 王晶, 等. 游离背阔肌肌皮瓣修复电烧伤后头部巨大缺损六例. 中华烧伤杂志, 2017, 33(8): 504-506.
8. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
9. 周健辉, 石惠文, 冷树立, 等. 踇趾腓侧折叠皮瓣修复拇指全指腹缺损. 中华手外科杂志, 2013, 39(2): 176-178.
10. 王增涛, 朱磊, 吴昊, 等. 足背分裂皮瓣在类圆形皮肤缺损修复中的应用. 中华显微外科杂志, 2008, 31(2): 92-94, 插5.
11. 胡涛涛, 常树森, 魏在荣, 等. 改良三纵五横法在股前外侧穿支皮瓣修复术前穿支定位中的应用研究. 中国修复重建外科杂志, 2021, 35(8): 1027-1032.
12. Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg, 1976, 58(6): 680-688.
13. 梁尊鸿, 潘云川, 林志琥. 带蒂背阔肌肌皮瓣早期修复颈部电烧伤深度创面. 组织工程与重建外科杂志, 2016, 12(5): 297-299.
14. 唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科杂志, 2006, 20(11): 1087-1089.
15. 胡祖良, 张元海, 倪良方, 等. 带蒂背阔肌皮瓣转移修复Ⅳ度烧伤创面. 浙江临床医学, 2016, 18(3): 469-470.
16. 韦平欧, 谭海涛, 江建中, 等. 背阔肌皮瓣移植重建屈肘屈指功能11例. 中华显微外科杂志, 2011, 34(6): 494-495.
17. 肖海涛, 王怀胜, 刘晓雪, 等. 游离背阔肌肌瓣结合中厚皮移植修复大面积全层头皮缺损九例. 中华烧伤杂志, 2015, 31(4): 310-311.
18. 王立宇, 崔英健, 范元军, 等. 背阔肌皮瓣的临床解剖学研究. 解剖学研究, 2014, 36(3): 164-167.
19. 马超, 陶然, 舒军, 等. 背阔肌肌皮瓣修复较大软组织缺损的方法及供区继发创面的处理. 中华烧伤杂志, 2020, 36(12): 1199-1203.
20. Dancey AL, Cheema M, Thomas SS. A prospective randomized trial of the efficacy of marginal quilting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
21. Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
22. Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back

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