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Novel Functional Split Latissimus Dorsi Muscle Flap for Upper and Lower Extremity Reconstruction: A Case Series
Fiona Fragomen and James Gatherwright, MD
Case Western Reserve University School of Medicine and The Cleveland Clinic Department of Plastic an
2024-01-15
Presenter: Fiona Fragomen
Affidavit:
James Gatherwright
Director Name: James Gatherwright
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: High-velocity ballistic injuries can result in composite injuries, often necessitating functional tissue and muscle reconstruction. In this case series, the split latissimus dorsi muscle flap (s-LDF) with thoracodorsal nerve transfer was used to restore functionality in both upper and lower extremities without compromising shoulder function, aesthetics, or flap strength.
Methods: This retrospective case series includes a 36-year-old male with no active knee extension, muscle grade power 0/5, profound quadriceps atrophy, and required assistance walking up and down steps post-ballistic injury. The patient underwent a functional free s-LDF transfer with end-to-end nerve thoracodorsal anastomosis with the femoral nerve. The second patient was a 26-year-old male suffering from ulnar nerve transection and no finger flexion who received a s-LDF transfer with thoracodorsal end-to-end anastomosis with the ulnar nerve and a Pulvertaft weave to the finger flexors.
Results: Post-operatively, the first patient regained complete knee extension with a muscle power grade of 5/5 within four months, marking a return to normalcy. The patient is back to work and can walk upstairs with mild difficulty descending and improving pain in the patella. The second patient showed promising initial results with observed finger flexion during surgery; however, they were lost to follow-up.
Conclusion: These cases highlight the novel split latissimus dorsi flap with thoracodorsal nerve transfer's success in restoring functional losses in the quadriceps and flexor digitorum due to ballistic injuries. The technique provides a promising avenue for trauma reconstruction, emphasizing the need for further studies to establish its broader applicability and long-term outcomes.
