Myocutaneous latissimus dorsi split pedicle flap for simultaneous reconstruction of elbow and breast: a case report

In this article we present a case of a large anterior elbow defect and an ipsilateral post-mastectomy defect reconstructed simultaneously using a single latissimus dorsi pedicle flap, split into two separate skin islands based on its independent vascular branches. To the best of our knowledge, no previous cases utilizing this approach for simultaneous treatment of mastectomy and distal arm tissue defects have been reported. Therefore, it was deemed relevant to share the technical aspects of the surgical procedure. The case involves a 61-year-old woman of Caucasian origin, diagnosed with breast cancer of the left breast. She underwent a modified radical mastectomy. Postoperative radiotherapy and chemotherapy were administered. During a chemotherapy infusion, extravasation of the chemotherapeutic agent led to necrosis in the left elbow and distal upper arm regions. The patient was primarily treated at another facility with skin grafting. We performed a reconstruction with a pre-expanded latissimus dorsi pedicle flap divided into two independent myocutaneous flaps for the upper extremity and mastectomy defects. The left breast underwent delayed combined reconstruction with the myocutaneous flap and a silicone implant. The upper extremity defect was simultaneously reconstructed with the other part of the same flap. The whole reconstruction included three operative stages. The blood supply to the transferred tissues was excellent and no complications occurred. The constant vascular anatomy of the thoracodorsal vessels and their intramuscular distribution pattern provides a robust amount of healthy tissue, which can be successfully used for treating a variety of defects within the flaps rotational arc. This allows for the reconstruction of different anatomical regions. Based on this case we demonstrate that coverage of a large elbow defect and simultaneous breast reconstruction is possible by splitting a pre-expanded pedicle latissimus dorsi flap into two independent flaps.