Latissimus dorsi free flap in orthopedic reconstructive surgery

In complex musculoskeletal diseases, soft-tissue reconstruction is usually the key to a good clinical result. Selection of an ideal flap is a critical step in successful reconstruction. We performed latissimus dorsi free flap transfers in 52 patients with orthopedic disorders from 1988 to 1993. Recipient sites were the lower extremities (44), upper extremities (six) and buttocks (two). The indications for flap surgery comprised chronic ulcer (seven), osteomyelitis (nine), compound fractures (28), crushing or avulsion injuries (six) and malignancy (two). All of the flaps survived and the therapeutic goals were satisfactorily achieved. One patient had revision of vascular anastomosis and five patients underwent skin regrafting. Of eight patients who complained of bulkiness of the flap, only two patients had debulking surgery. No chronic infection occurred in either skeletal or soft tissue after flap coverage in any patients. Two of five heel flaps had initial ulcers and became endurable after one year. Two patients with malignancy were treated with wide resection and coverage with the flap. The esthetic and functional morbidity of the donor site was minimal. Through several modifications--segmentalization, tailoring, thinning and multiple islanding--the flaps become so versatile that they can be applied to different kinds of tissue defects in different locations of the body. This series of patients revealed the flap to be the most useful armament in the reconstruction of complex musculoskeletal diseases, particularly for orthopedic microsurgeons.