Clinical application of free latissimus dorsi lobulated musculocutaneous flap for repair of tissue defect of the shank

Objective To explore the clinical outcomes of free latissimus dorsi lobulated musculocutaneous flap for repairing the soft tissue defects of the shank. Methods From January 2011 to December 12, free latissimus dorsi lobulated musculocutaneous flap was transferred to repair soft tissue defects of the shank in 22 cases. There were 16 males and 6 females retrospectivelyanalyzed, with an average age of 37.5±2.5 years. The wounds all had tendon,bone and/or internal fixation exposed. The size of the defect area was 18 cm×10 cm to 28 cm×15 cm. At first, the site of perforator vessels was determined by Doppler as the center, then the lobulated flaps were designedaccording to the wound shape and size. During the operation, the thoracic and dorsal nerves and part of latissimus dorsi muscle were preserved, and the myocutaneous flap was formed into lobulated myocutaneous flap. Finally, the pedicle was dissociated to the appropriate lengthwhen only the vascular pedicle was connected with the flap. After the combination of the two lobulated myocutaneous flaps, the skin flap was trimmed, and the subcutaneous fat was removed in a step-like way from the peripheral to the point of perforation of vascular cutaneous branches. Only the dermis was retained around the integral skin flap, and the blood supply of the skin flap was observed at the same time to prevent the injury of perforating vessels. The transplantation of musculocutaneous flap was performed to repair the leg wound. All donor sites were sutured directly. The flap survival was observed according to the comprehensive evaluation standard of hand surgery. Results All the 22 flaps survived, and the size of lobulated musculocutaneous flap was 20 cm×12 cm to 30 cm×16 cm. No vascular crisis happened, and all skin grafts survived in donor sites. 22 cases were follow-up for 6 to 24 months. The flaps were supple and elastic with nearly normal color. There was no bulkiness. Sensory function recovered well and two-point discrimination (2-PD) was about 3.5-5.0 cm. The function and appearance of the foot and ankle was good. According to the operative hand surgery function evaluation of flap, the results were excellent in 13 cases,good in 8 cases, fair in 1 case, with excellent and good rate of 95.45% (21/22). 1.0 cm×0.5 cm of the distal of flap was necrosis in 1 case and healed by dress changing. Conclusion The free latissimus dorsi lobulated musculocutaneous flap is an improvement of the traditional latissimus dorsi flap. The survival rate of musculocutaneous flap is high and the clinical effect of repairing soft tissue defect of lower leg is satisfactory. Key words: Leg; Soft tissue injuries; Surgical Flaps; Treatment outcome