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What about the donor site morbidity - how invasive is the free latissimus dorsi flap?

Nikolaus Wachtel1, Riccardo E Giunta1, Marc Hellweg1

  • 1Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.

Bone & Joint Open
|December 18, 2024
PubMed
Abstract

Insights

Free latissimus dorsi muscle (LDM) flap surgery significantly reduces shoulder strength and range of motion (ROM). Donor site morbidity is influenced by handedness, with non-dominant side harvests causing greater impairment.

Area of Science:

  • Plastic Surgery
  • Orthopedic Surgery
  • Musculoskeletal Research

Background:

  • The latissimus dorsi muscle (LDM) flap is a common procedure in reconstructive surgery.
  • Limited data exists on the specific morbidity associated with LDM flap harvest.
  • Objective assessment of donor site morbidity is crucial for patient outcomes.

Purpose of the Study:

  • To prospectively investigate the morbidity of free latissimus dorsi muscle (LDM) flap harvest.
  • To quantify the impact of LDM flap harvest on shoulder strength and range of motion (ROM).
  • To analyze the influence of patient handedness on flap harvest morbidity.

Main Methods:

  • A prospective study comparing patients undergoing free LDM flap surgery with a control group (n=100).
  • Assessment of shoulder joint strength and ROM in both groups, considering handedness.
  • Detailed evaluation of 40 patients post-LDM flap surgery.

Main Results:

  • LDM flap harvest resulted in a significant reduction in shoulder strength (9.0%–13.8%) and ROM.
  • Pre-existing strength and ROM differences between dominant and non-dominant sides were exacerbated by non-dominant side flap harvest.
  • Flap harvest on the dominant side diminished the observed strength and ROM deficits.

Conclusions:

  • Free LDM flap surgery leads to significant impairment of shoulder strength and ROM.
  • Donor site morbidity is significantly influenced by the side of flap harvest relative to patient handedness.
  • Harvesting from the non-dominant side potentiates functional deficits, while dominant side harvest mitigates them.

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