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Latissimus dorsi-rib osteomyocutaneous flaps for composite cranial defects: a case series and anatomical study
M. Rezaei, M.J. Annunziata, R. Drake, S. Nagel, M. Bain, S. Murthy, B. Bassiri Gharb, A. Rampazzo
Cleveland Clinic Foundation Department of Plastic Surgery
2019-02-14
Presenter: Michael Annunziata
Affidavit:
The presenter, Michael Annunziata, has accurately represented the proportion of original work that he has conducted for this project within the submission fields below (20% data acquisition, 20% analysis and interpretation, 40% abstract drafting and revision). The material proposed for presentation has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Antonio Rampazzo
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Latissimus dorsi-rib osteomyocutaneous flaps (LDRF) can be used to reconstruct large composite cranial defects--restoring skull contour, protecting the brain, and improving neurological status. There are benefits to using autologous rib instead of alloplastic material, however rib viability relies on good blood supply. Here we present outcomes of 6 patients treated with the LDRF flap and provide a cadaveric anatomical study of its blood supply.
Methods: Defect size, etiology, previous reconstruction attempts, and complications of 6 patients treated with LDRF were assessed retrospectively. Twenty fresh, latex-injected cadaver sides were dissected to locate and measure vessels connecting the thoracodorsal and intercostal artery systems.
Results: Patients had a history of at least 2 failed reconstructions for defects secondary to gunshot injury, post-CVA cranioplasty, post-ablation irradiation, and post-frontal ICH cranioplasty. Patients were followed for 5 to 35 months. All patients had stable reconstructions. Headache resolved in 2 patients and neurological status improved in 2 patients. No perforators were found for the 7th rib. Perforators at the 8th rib had the longest pedicle (4.26±1.52 cm), but were frequently absent. Distance from midline to first perforator was not different in each rib (p = 0.499). The 10th (4.65±2.01) and 9th ribs (3.70±1.63) had the highest number of perforators and greatest estimated blood supply.
Conclusion: LDRF can address large cranial defects and improve functional outcome with negligible donor site morbidity. The 10th rib has the best vascular supply for use in LDRF. For flaps with two ribs, we recommend the 9th and 11th.
