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The Split-Latissimus Dorsi Muscle in Free Flap Extremity Reconstruction: A Forgotten Gem
Paul Durand, MD
James Gatherwright, MD
Rafael Couto, MD
Angela Kaza, MD
Gregory Lamaris, MD
Bram Kaufman, MD
Cleveland Clinic Foundation
2016-01-30
Presenter: Paul Durand, MD
Affidavit:
I certify that the material int his abstract has not been previously published or presented at a major meeting.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
To our knowledge, this is the first study of its kind to successfully demonstrate a single surgeon's experience using the split-latissimus dorsi muscle (SLDM) flap in extremity reconstruction. We hypothesize that this reconstruction modality, compared to a full LD flap, can offer a versatile and efficacious solution in patients who require free tissue coverage while minimizing the negative effects associated with full muscle harvest.
Patients undergoing extremity reconstruction with SLDM flaps at a single, tertiary-care institution from 2012 to 2015 were reviewed. Patient demographics, wound characteristics, medical comorbidities, surgical characteristics, complications, and reoperations were examined. Descriptive statistical analysis, including Chi-Square was performed.
Thirty-two patients were included with mean follow-up of 20.9 months. Average BMI was 29.8. Fifty-three percent were smokers. Most common comorbidity was hypertension (31%) followed by diabetes (16%). Majority of wounds were related to MVA (43%) followed by falls (22%). Distal tibial injury was the most common indication (28%). Average operative time was 344 minutes. Only one complete flap loss flap loss occurred. Reoperation rate was 0%. Four patients went on to amputation for orthopedic issues (non-union/pain). Female gender and injury level were significantly associated with amputation (p=0.02 and p=0.05, respectively).
Free tissue extremity reconstruction with the SLDM flap is shown as a safe and versatile reconstructive alternative. Compared to the full LD flap, the SLDM flap minimizes donor site functional morbidity while providing a less bulky, more easily contourable option. Furthermore, the SLDM flap can be easily harvested in the supine position, greatly minimizing operative time.
