Supercharged latissimus dorsi muscle flap for coverage of the problem wound in the lower back

Described is the "supercharging" of a latissimus dorsi muscle flap for coverage of an irradiated nonhealing wound of the lumbar area of the back. Nonhealing wounds of the lower back pose difficult management problems. In the face of radiation therapy, infection, and the presence of foreign materials, they can have the potential for disastrous outcomes. Exposed bone and prosthetic materials in an irradiated bed were covered by turning a latissimus dorsi muscle flap over its lower paraspinous origin and anastomosing the thoracodorsal artery and vein to the ipsilateral superior gluteal vessels. Postoperatively, the patient's wound healed without incident, and the muscle flap and skin graft provided a stable and durable reconstruction. Subsequent duplex Doppler imaging demonstrated a significant inflow to the flap from the superior gluteal artery and vein anastomosed to the thoracodorsal artery and vein of the muscle.