Late necrosis of a latissimus dorsi free flap

We report a case of a latissimus dorsi free-muscle transfer that received isolated blunt trauma to the vascular pedicle 7 months after surgery. There was complete necrosis of this muscle unit, confirmed by biopsy. The muscle was tangentially excised, and a skin graft was successfully laid on the tissue beneath the muscle. Although this is an isolated case report, it raises interesting questions concerning the revascularization of free-tissue transfers. It is possible that because of significant flow rates in a small segment of tissue there is limited stimulation for revascularization to develop. What role smoking plays in this clinical situation also remains to be determined.