OBJECTIVETo report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps.

METHODSSix patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cm multiply 6 cm to 30 cm multiply 18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery.

RESULTSAll flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh) or was closed primarily (3 cases) and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.

CONCLUSIONOur experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

Adult ; Arm Injuries ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocutaneous Flap ; blood supply ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; etiology ; surgery ; Superficial Back Muscles ; transplantation ; Treatment Outcome

BACKGROUND: We intended to clarify the hypothesis that minimally invasive total hip arthroplasty (MI-THA) leads to less tissue damage and inflammatory response than does conventional total hip arthroplasty (C-THA). METHODS: We performed 30 cases of THA between September 2005 and May 2006 and evaluated these cases prospectively. We chose 15 MI-THA cases for the study group and another 15 C-THA cases for the control group. We checked skeletal muscle marker enzymes, such as serum creatinine kinase and aldolase, the pro-inflammatory cytokines, interleukin (IL)-6 and 8, and the anti-inflammatory cytokines, IL-10 and IL-1 receptor antagonist (ra) the day before surgery and at postoperative days 1, 7, and 14. RESULTS: On postoperative days 1 and 3, the study group showed significantly lower serum creatinine kinase, IL-6, IL-10, and IL-1ra values than those in the control group. Additionally, IL-8 was significantly lower on day 7 after surgery. CONCLUSIONS: These data show that MI-THA decreased the release of muscle marker enzymes due to tissue damage immediately after surgery and minimized the inflammatory response related to the surgery during the early postoperative period.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/*adverse effects ; Biological Markers/blood ; Creatine Kinase/blood ; Female ; Fructose-Bisphosphate Aldolase/blood ; Humans ; Interleukin 1 Receptor Antagonist Protein/blood ; Interleukin-10/blood ; Interleukin-6/blood ; Interleukin-8/blood ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/adverse effects ; Soft Tissue Injuries/*blood/etiology