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[Endoscopically-assisted latissimus dorsi muscle harvest in a young child]
T Schoeller1, G M Huemer, A Otto-Schoeller
1Universitätsklinik für Plastische und Wiederherstellungschirurgie, Innsbruck, Osterreich. thomas.schoeller@uibk.ac.at
Insights
Endoscopically-assisted free tissue transplantation using the latissimus dorsi muscle flap offers a minimally invasive solution for extensive pediatric reconstructive surgery. This technique significantly reduces donor-site morbidity, ensuring excellent functional and aesthetic outcomes in young patients.
Area of Science:
- Microsurgery
- Pediatric reconstructive surgery
- Minimally invasive surgery
Background:
- Free tissue transplantation is a standard reconstructive surgery method, even in infants.
- The latissimus dorsi muscle flap is ideal for pediatric use due to vessel size.
- Donor-site morbidity, including scar contracture and limited shoulder movement, is a disadvantage of traditional latissimus dorsi flaps.
Observation:
- A 3-year-old boy with a subtotal heel amputation and soft-tissue necrosis underwent latissimus dorsi muscle flap transplantation.
- The flap was harvested using an endoscopically-assisted technique through a single, 2 cm axillary incision.
- The patient experienced uneventful flap healing and stable heel condition at 30 months follow-up.
Findings:
- Endoscopically-assisted harvest significantly reduces donor-site morbidity compared to traditional methods.
- The minimally invasive approach resulted in a nearly invisible scar and no noticeable growth impairment.
- Excellent functional recovery and stable defect coverage were achieved in the pediatric patient.
Implications:
- Minimally invasive techniques enhance the safety and efficacy of free microvascular muscle flaps in pediatric patients.
- Endoscopic harvesting of the latissimus dorsi flap is a viable option to minimize donor-site complications.
- This approach improves therapeutic success and patient outcomes in extensive traumatic defects in infants and children.
Abstract:
Free tissue transplantation is nowadays regarded as an established method in reconstructive surgery - even in infants. Adequate diameters of vessels for microsurgical anastomosis have been shown in numerous studies. Especially the latissimus dorsi muscle seems to be ideal as a standard flap in this age group. The main disadvantage of this muscle flap lies in its donor-site morbidity with the risk of scar contracture and limitation of shoulder movement. A possible solution to this problem is the endoscopically-assisted harvest of this muscle. A three-year old boy sustained a subtotal amputation of his right heel with consecutive necrosis of soft-tissue. After debridement, a latissimus dorsi-muscle flap was transplanted to cover the defect. The flap was harvested endoscopically-assisted through a single, 2 cm long incision in the left axilla. Healing of the flap was uneventful. At 30 months follow-up the patient showed stable conditions at the right heel without limitations of movement and a hardly visible scar in the left axilla without any noticable growing impairment. Free microvascular muscle-flaps are the treatment of choice in infants with extensive traumatic defects. With the use of minimally invasive operation techniques it is possible to significantly reduce donor-site morbidity and increase therapeutic success even in the youngest patients.