Clinical, Cosmetic and Investigational Dermatology (Mar 2023)
Application of Three Different Types of Pedicled Latissimus Dorsi Flaps in Repairing Nearby Deep Soft Tissue Defects: Cosmetic Result and Shoulder Functionality Evaluation in One Center
Abstract
Ming-Wei Yu,1,2,* Min Wang,2,* Qian Wang,2 Yong Chen,2 Si-Ming Yuan2 1Department of Plastic Surgery, Jinling Hospital, Nanjing, Jiangsu, 210002, People’s Republic of China; 2Department of Plastic Surgery, Wuhan Third Hospital, Wuhan, Hubei, 430000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Si-Ming Yuan, Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, People’s Republic of China, Email [email protected]: The latissimus dorsi (LD) flap has generally been considered a workhorse flap in clinics. However, the impairment of shoulder function and the dramatic appearance in the donor site are the major problems associated with traditional latissimus dorsi myocutaneous flap (LDMF). Here, we analyzed the reliability of three types of LD flaps in repairing deep soft tissue defects in the upper limbs, shoulder, back, and chest wall.Methods: From December 2016 to December 2020, 21 patients from our center underwent reconstruction of deep soft tissue defects using different types of LD flaps. The distribution of the thoracodorsal artery and the location of its branches were confirmed by imaging examination. Based on the defects, traditional LDMF, thoracodorsal artery perforator flap with capillary perforators (TAPcp), or low-skin-paddle pedicled LDMF was selected and specifically designed for each patient. The appearance satisfaction and shoulder functional of daily life recovery were evaluated.Results: A total of 12 traditional LDMF, 4 TAPcp, and 5 low-skin-paddle pedicled LDMFs were used. All flaps survived well. The donor site was sutured directly with satisfactory appearance (n = 7) or repaired using skin grafts (n = 14). Compared to traditional LDMF, TAPcp and low-skin-paddle pedicled LDMF have faster shoulder function of daily life recovery.Conclusion: Based on the characteristics of defects, personalized design of different types of LD flaps is a reliable option to repair different defects.Keywords: latissimus dorsi myocutaneous flap, thoracodorsal artery perforator flap with capillary perforators, low-skin-paddle pedicled flap, shoulder function
