Durability and versatility of free lattismus dorsi muscle flap in leg defects

Document Type : Original Article


1 Department of plastic surgery, Faculty of Medicine, Sohag University.

2 Department of Plastic Surgery, Faculty of Medicine, Sohag University.

3 Department of plastic surgery, Faculty of Medicine, Sohag University


Background: The objective of this study was to assess the outcome of free lattismus dorsi muscle flap used for soft tissue reconstruction of leg defects.
Methods: This prospective non-randomized study was conducted on 13 patients with leg defects of different causes attended emergency unit and outpatient clinic of plastic surgery department in Sohag University Hospital in the period between June 2013 and May 2014. Durability of coverage, flap success, infection, pain and overall satisfaction were studied.
Results: Complete flap survival was 92.3% with only one total flap loss.
Conclusion: The choice of the flap to cover leg defects should be tailored according to favorable criteria as regarding patient age, defect site, size and depth, presence or absence of infections.
The free lattismus dorsi muscle flapcan cover huge sized defects, robust blood supply and less need for secondary thinning operations.

1- Fraccalvieri M, Boqetti P, and Verna G, et al. (2008): Ditally based fasiocutaneous sural flap for foot reconstruction: a retrospective review of 10 years experience. Foot Ankle Int; 29:191–8.
2- Akhtar S, Hameed A. (2006): Versatility of the sural fasiocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg; 59:839–45.
3- McGregor IA and Morgan G. (1973): Axial and random pattern flaps. Br J Plast Surg; 26:202-13.
 4- Jeng SF and Wei FC (1997). Classification and reconstructive options in foot plantar skin avulsion injuries. Plast Reconstr Surg; 99:1695-705
5- Santanelli di Pompeo et al. (2015): Microvascular reconstruction of complex foot defects, a new anatomo-functional classification. Injury Int. J. Care Injured 46: 1656–1663.
6- Demirtas y et al. (2009): comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. In Wiley InterScience Microsurgery.
7- Yildirim S, Gideroglu K and Akoz T. (2003): Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg.; 19:225-233.
8- Melissinos EG and Parks DH (1989): Post-trauma reconstruction with free tissue transfer: analysis of 442 consecutive cases. J Trauma; 29:1095-102.
9- Percival NJ, Sykes PJ and Earley MJ (1989): Free flap surgery: the Welsh Regional Unit experience. Br J Plast Surg; 42:435-40.
10-Khouri RK and Shaw WW. (1989): Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma; 29:1086-1094.
11-Byrd HS, Cierny G III, Tebbetts JB. (1981): The management of open tibial fractures with associated soft tissue loss: External pin fixation with early flap coverage. Plast. Reconstr. Surg.; 68:73-82.
12- Godina M. (1986): Early microsurgical reconstruction of complex trauma of the extremities. Clin Plast Surg.; 13:619.
13-Yaremchuk MJ, Brumback JJ, Manson PN, et al (1982): Acute and definitive management of traumatic osteocutaneous defects of the lower extremity. Plast Reconstr Surg.; 80:1-14.
14- Steirt AB, Gohritz A, Schreiber TC et al (2009): Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VA C) therapy worse or worth? J Plast Reconst Aestht Surg. May; 62(5):675-6"83.
15-Hou Z, Irgit K, Strohecker KA, et al. (2011): Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma. 71(6):1705-1708.
16-Calderon W, Chang N, Mathes SJ. (1986):  Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg; 77:785-94.
17- Chang N, Mathes SJ. (1982): Comparison of the effect of bacterial inoculation in musculocutaneous and random-pattern flaps. Plast Reconstr Surg; 70:1-10.
18- Mathes SJ and Nahai F (1982): Clinical applications for muscle and myocutaneous flaps. Mosby, St Louis.
19-Nasir S and Aydin MA (2008): Reconstruction of soft tissue defect of lower extremity with free SCIA/SIEA Flap. Ann Plast Surg; 61:622– 626.
20- Guerra AB, Gill PS, and Trahan CG, et al. (2005): Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps. J Reconstr Microsurg.; 21:137Y143.
21-Anthony JP, Mathes SJ, Alpert BS (1991): The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment. Plast Reconstr Surg 88:311.
22- May JW. Jupiter JB, Gallico GG, et al (1991): Treatment of chronic traumatic bone wounds. Microvascular free tissue transfer: a13-year experience in 96 patients. Ann Surg; 214:241.
23- Kang MJ. Chung CH. Chang YJ. Kim KH.  (2013): Reconstruction of the Lower Extremity Using Free Flaps. Arch Plast Surg; 40:575-583.
24- Christy et al (2012): Early Postoperative Outcomes Associated with the Anterolateral Thigh Flap in Gustilo IIIB Fractures of the Lower Extremity. Lippincott Williams & Wilkins
25- Yazar S, Lin CH, and Lin YT, et al. (2006): Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg.; 117:2468Y2475.