Flank Reconstruction of Large Soft Tissue Defect with Reverse Pedicled Latissimus Dorsi Myocutaneous Flap: A Case Report.

Song, Seung Yong; Kim, Da Han; Kim, Chung Hun

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Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2011;38(6):894-898.
Published online November 1, 2011.

Flank Reconstruction of Large Soft Tissue Defect with Reverse Pedicled Latissimus Dorsi Myocutaneous Flap: A Case Report.

Seung Yong Song, Da Han Kim, Chung Hun Kim

Department of Plastic and Reconstructive Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Gyeonggi, Korea. cooldahan@naver.com

Abstract

PURPOSE
Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. METHODS: A 24-year-old male patient had 13.0x7.0x14.0cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. 24x25cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with 2110cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries.
RESULTS
Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable.
CONCLUSION
The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

Keywords: Reverse latissimus dorsi myocutaneous flap; Defect; Lumbar; Flank; Reconstruction

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