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Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction: Five-Year Consecutive
Harvey Chim1, Rachel Cohen-Shohet, Mariel M McLaughlin
1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
The Journal of Bone and Joint Surgery. American Volume
|June 30, 2020
Summary
The free split latissimus dorsi flap offers a reliable option for lower-extremity reconstruction with minimal donor site morbidity. This technique preserves latissimus dorsi muscle function, proving advantageous for trauma cases.
Area of Science:
- Plastic Surgery
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- The free split latissimus dorsi flap is an alternative to traditional latissimus dorsi flaps for lower-extremity reconstruction.
- Harvesting in the supine position and preservation of muscle function via nerve division offer advantages.
- Minimal donor site morbidity is a key benefit.
Purpose of the Study:
- To evaluate the efficacy and donor site morbidity of the free split latissimus dorsi flap for lower-extremity reconstruction.
- To assess patient outcomes including muscle strength and shoulder function.
Main Methods:
- A 5-year series of 42 free split latissimus dorsi muscle flaps for lower-extremity reconstruction was reviewed.
- Donor site morbidity was assessed by evaluating the strength of the remaining latissimus dorsi muscle.
- Shoulder function was measured using validated scoring systems (DASH, ASES, SPADI).
Main Results:
- The majority of wounds (71%) were due to acute trauma.
- A high success rate of 95% was observed for the flap procedures.
- All patients demonstrated Medical Research Council (MRC) grade 5 strength in the remaining latissimus dorsi muscle, with negligible impact on shoulder function scores.
Conclusions:
- The free split latissimus dorsi flap is a reliable and large flap for lower-extremity reconstruction.
- It demonstrates negligible donor site morbidity.
- This technique is particularly beneficial for resurfacing lower extremities following trauma.
