Experience with the latissimus dorsi flap

A review of 65 applications of the latissimus dorsi flap based on the thoraco-dorsal vessels to recipient sites in the head and neck area (10), on the torso (22), in the upper extremity (9) and in the lower extremity (24) in 62 patients with malignancies (28) and congenital deformities (6) is presented. Thirty-five flaps were transplanted with microsurgical vascular technique, while 30 flaps were pedicled. Vascular thrombosis at the anastomotic site was seen in 4/35 free tissue transplants and was successfully managed in 3 cases with an overall survival rate of 97% in this group, while all pedicled flaps survived. Healing complications including haematomas and wound infections were related to the nature of the recipient site and most commonly seen in the lower leg after resection of infected bone. In 3 cases leg amputations were performed within 6 months after the reconstruction, while 6 patients had secondary operations for tibial pseudoarthroses. Donor site morbidity was insignificant, without permanent, functional losses. It is concluded, that the thoracodorsal unit is a versatile and safe flap for reconstructive purposes.