Related Experiment Video
Updated: Sep 16, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Improving the Versatility of the Latissimus Dorsi Myocutaneous Flap Using a Simultaneously Pre-expanded Adjacent Flap
Wenjing Wang1, Yutong Yuan1, Zixiang Chen1
1Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China.
Background:
Harvesting a large latissimus dorsi myocutaneous flap (LDMF) is constrained by donor-site closure. When the skin paddle width exceeds 10 cm, direct closure is difficult. This report describes a novel technique using a simultaneously pre-expanded adjacent flap to achieve primary LDMF donor-site closure and reviews reported closure strategies.
Methods:
Between 2011 and 2025, 16 patients underwent reconstruction with a pre-expanded LDMF combined with a simultaneously pre-expanded adjacent flap for donor-site closure. Demographic data, defect characteristics, flap dimensions, and outcomes were analyzed. Additionally, a literature review was conducted to evaluate LDMF donor-site closure strategies.
Results:
The mean age of patients in this study was 14.5 (range 5-36) years. The etiologies associated with study inclusion included post-burn contracture, congenital melanocytic nevus, and hemangioma. Defect sizes ranged from 25 × 10 cm to 32 × 21 cm, and the pre-expanded LDMFs measured 25 × 12.5 cm to 35 × 23 cm. In all cases, the pre-expanded adjacent flap enabled tension-free primary LDMF donor-site closure. Complete flap survival was achieved in 15 patients, while one patient experienced distal LDMF necrosis. No donor-site complications were observed. A narrative review (51 studies, 512 LDMFs) demonstrated that selection of donor site closure method has depended on skin paddle width and recipient site characteristics, forming the basis of a literature-informed framework for preoperative planning.
Conclusions:
In selected patients requiring large LDMF harvest for staged defect reconstruction, simultaneous expansion of adjacent flap represents a feasible approach to achieve tension-free primary donor-site closure.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .
