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Split Latissimus Dorsi Transfer as a Novel Approach for Upper Extremity Wound Coverage and Restoration of Function: A Case Report
Michael Wells MEng; Grzegorz Kwiecien, MD; Kyle Chepla, MD; James Gatherwright, MD
Case Western Reserve University School of Medicine
2021-02-15
Presenter: Michael Wells
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: James Gatherwright
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
Management of complex extremity wounds remains challenging, requiring restoration of bone support, adequate soft-tissue coverage, and function. Free split latissimus dorsi flap (fSLDF) is novel reconstruction option with limited donor-site morbidity.
Materials and Methods
A 35-year-old male suffered ballistic injury with segmental loss of ulnar shaft/ulnar nerve, loss of superficial flexor compartment and partial injury to median nerve and deep flexor compartment, with infection and scar formation. First stage of reconstruction involved debridement and plate fixation of ulnar shaft over antibiotic spacer. Second stage involved coverage of defect with fSLDF raised on descending branch of thoracodorsal artery. Thoracodrosal nerve was coapted to proximal motor stump of ulnar nerve. Tendinous portion of flap was inserted at medial epicondyle and distal portion was used for reconstruction of four flexor digitorum superficialis tendons. Third stage involved completion of bone reconstruction with autologous bone graft harvested from femur using Masquelet principle and skin grafting.
Results:
Three months after reconstruction, there was stable wound coverage and voluntary grip with functional transferred muscle and no clawing, without seroma complications. Radiographs confirmed healing bone with stable hardware and no evidence of loosening/osteomyelitis.
Conclusion
Innervated fSLDF is a novel approach that offers flexibility for size/function of transferred muscle. It is advantageous over standard LDF for limiting dissection and preserving motor function in donor-site while providing functional motor for powering tendons. This case report of fLSDF demonstrates restoration of flexor function to the flexor compartment and ulnar nerve and well-vascularized tissue coverage for hardware and bony construct.
