OBJECTIVE: To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back. METHODS: Between August 2018 and January 2023, the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients. There were 5 males and 3 females with the age ranged from 21 to 56 years (mean, 35.4 years). Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases. The causes of injury were chronic infection of skin and bone exposure in 2 cases, secondary wound after extensive resection of skin and soft tissue tumor in 4 cases, and wound formation caused by traffic accident in 2 cases. Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm. The disease duration ranged from 12 days to 1 year (median, 6.6 months). A pedicled latissimus dorsi myocutaneous flap was designed and harvested. The flap was divided into A/B flap and then were folded to repair the wound, with the donor area of the flap being pulled and sutured in one stage. RESULTS: All 7 flaps survived, with primary wound healing. One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change. The incisions of all donor sites healed by first intention. All patients were followed up 6 months to 4 years (mean, 24.7 months). The skin flap has a good appearance with no swelling in the pedicle. At last follow-up, 6 patients had no significant difference in bilateral shoulder joint motion, and 2 patients had a slight decrease in abduction range of motion compared with the healthy side. The patients' daily life were not affected, and linear scar was left in the donor site. CONCLUSION The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation, less damage to the donor site, and quick recovery after operation.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Plastic Surgery Procedures ; Myocutaneous Flap/surgery* ; Shoulder/surgery* ; Skin Transplantation ; Superficial Back Muscles/transplantation* ; Soft Tissue Injuries/surgery* ; Wound Healing ; Treatment Outcome ; Perforator Flap

OBJECTIVE: To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. METHODS: Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. RESULTS: All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). CONCLUSION The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
Male ; Female ; Humans ; Adult ; Myocutaneous Flap/surgery* ; Plastic Surgery Procedures ; Thoracic Wall/surgery* ; Rectus Abdominis/transplantation* ; Skin Transplantation ; Breast Neoplasms/surgery* ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Objective: To observe the clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower limbs. Methods: A retrospective observational study was conducted. From December 2017 to December 2020, 8 patients with large skin and soft tissue defect caused by degloving injury in lower extremity were admitted to Ningbo No.6 Hospital, including 5 males and 3 females, aged from 39 to 75 years, with wound area of 25 cm×12 cm-61 cm×34 cm. The free latissimus dorsi myocutaneous flap with latissimus dorsi muscle in the width of 12-15 cm and flap area of 20 cm×8 cm-32 cm×8 cm was used to repair the skin and soft tissue defect of bone/tendon exposure site or functional area. The other defect was repaired with bilayer artificial dermis, and the flap donor site was sutured directly. After the artificial dermis was completely vascularized, the split-thickness skin graft from thigh was excised and extended at a ratio of 1∶2 to 1∶4 and then transplanted to repair the residual wound, and the donor site of skin graft was treated by dressing change. The survival of latissimus dorsi myocutaneous flap, artificial dermis, and split-thickness skin graft after operation was observed, the interval time between artificial dermis transplantation and split-thickness skin graft transplantation was recorded, and the healing of donor site was observed. The appearance and function of operative area were followed up. At the last outpatient follow-up, the sensory recovery of flap was evaluated by British Medical Research Council evaluation criteria, the flap function was evaluated by the comprehensive evaluation standard of flap in Operative Hand Surgery, the scar of lower limb skin graft area and thigh skin donor area was evaluated by Vancouver scar scale, and the patient's satisfaction with the curative effects was asked. Results: The latissimus dorsi myocutaneous flap survived in 6 patients, while the distal tip of latissimus dorsi myocutaneous flap was partially necrotic in 2 patient and was repaired by skin grafting after resection at split-thickness skin grafting. The artificial dermis survived in all 8 patients after transplantation. The split-thickness skin graft survived in 7 patients, while partial necrosis of the split-thickness skin graft occurred in one patient and was repaired by skin grafting again. The interval time between artificial dermis transplantation and split-thickness skin graft transplantation was 15-26 (20±5) d. The donor site of latissimus dorsi myocutaneous flap healed with linear scar after operation, and the thigh skin graft donor site healed with scar after operation. The patients were followed up for 6-18 (12.5±2.3) months. The color and elasticity of the flap were similar to those of the surrounding skin tissue, and the lower limb joint activity returned to normal. There was no increase in linear scar at the back donor site or obvious hypertrophic scar at the thigh donor site. At the last outpatient follow-up, the sensation of the flap recovered to grade S₂ or S₃; 3 cases were excellent, 4 cases were good, and 1 case was fair in flap function; the Vancouver scar scale score of lower limb skin graft area was 4-7 (5.2±0.9), and the Vancouver scar scale score of thigh skin donor area was 1-5 (3.4±0.8). The patients were fairly satisfied with the curative effects. Conclusions: In repairing the large skin and soft tissue defect from degloving injury in lower extremity, to cover the exposed bone/tendon or functional area with latissimus dorsi myocutaneous flap and the residual wound with artificial dermis and extended split-thickness skin graft is accompanied by harvest of small autologous flap and skin graft, good recovery effect of functional area after surgery, and good quality of healing in skin grafted area.
Cicatrix/surgery* ; Degloving Injuries/surgery* ; Dermis/surgery* ; Female ; Humans ; Lower Extremity/surgery* ; Male ; Mammaplasty ; Myocutaneous Flap ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Superficial Back Muscles/surgery* ; Treatment Outcome

Objective: To investigate the method and effect of free anterolateral thigh myocutaneous flap combined with pedicled latissimus dorsi myocutaneous flap transfer for functional reconstruction after resection of huge shoulder tumor. Methods: The clinical data of 6 patients who were treated with pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap to repair large-area complex defects after shoulder tumor resection at Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital from December 2015 to December 2020 were retrospectively analyzed. There were 2 males and 4 females, with an average age of 41.7 years (range:29 to 56 years). There were 2 cases of synovial sarcoma,2 cases of phylloid cell sarcoma,1 case of liposarcoma and 1 case of fibrosarcoma. Before this operation, tumor resection had been performed for 1 to 5 times on each case,and the course of disease was 6 to 24 months. Pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap were used to repair soft tissue defects and reconstruct deltoid function. Postoperative flap status, complications, appearance and function of upper limbs and tumor recurrence were recorded. Results: Six patients were followed up for an average of 21.6 months (range: 12 to 36 months). There were no serious complications after operation,and all flaps survived. No tumor recurrence was found. The appearance of shoulder contour reconstructed by flaps was satisfactory. The reinnervation effect of lateral femoral muscle was confirmed recovered smoothly by neuroelectromyography 3 months after operation. Shoulder function was mildly limited in 3 patients,moderately limited in 2 patients and severely limited in 1 patient. All patients reported significant improvement in shoulder discomfort.The overall functional results of all patients were satisfactory. Conclusion: Combined myocutaneous flaps transplantation can perfectly repair the wound left after the resection of huge shoulder tumor,minimize the recurrence of tumor,reconstruct the function of shoulder joint and greatly improve the quality of life of patients.
Male ; Female ; Humans ; Adult ; Myocutaneous Flap ; Thigh ; Superficial Back Muscles ; Shoulder ; Quality of Life ; Retrospective Studies ; Skin Transplantation ; Plastic Surgery Procedures/methods* ; Mammaplasty ; Upper Extremity ; Sarcoma ; Treatment Outcome ; Soft Tissue Injuries

Objective: To evaluate the functional outcomes of repairing parietal and occipital defect after surgery for cancer by lower trapezius myocutaneous flap with latissimus dorsi. Methods: Retrospective analyses of eight patients were performed who underwent repairing parietal and occipital defects with dural exposure after surgeries for cancers from January 2015 to January 2020 in Tianjin Institute of Occupational Disease Control and Prevention (Tianjin Workers Hospital) and the Second Hospital of Tianjin Medical University, including 6 males and 2 females aged from 26 to 68 years old. The method for harvesting the lower trapezius myocutaneous flap was improved and thus the lower trapezius myocutaneous flaps with latissimus dorsi were used for repairing the parietal and occipital defects. The area of myocutaneous flap depended on the size of defect. Results: The defects were repaired with the flaps with areas ranging from 12 cm×8 cm to 17 cm×15 cm. Seven flaps survived after surgery and the wounds were healed. Blisters and bruise were observed at the distal end of one flap 2 days after operation, which were cured with dressing change for 10 days. All cases were followed-up for six months, with normal functions of the shoulder joints, aside from mild hypertrophic scar in donor site on the back. Conclusion: It is feasible to use the lower trapezius myocutaneous flap with latissimus dorsi to repair the parietal and occipital defect after surgery for cancer, and the clinical effect is satisfactory.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Myocutaneous Flap ; Neoplasms ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Superficial Back Muscles ; Treatment Outcome

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.
Breast Neoplasms ; Breast ; Drug Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Myocutaneous Flap ; Radiotherapy ; Rectus Abdominis ; Surgery, Plastic

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.
Breast Implants ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap* ; Reconstructive Surgical Procedures ; Silicon* ; Silicones* ; Skin ; Superficial Back Muscles* ; Surgery, Plastic ; Tissue Expansion Devices* ; Tissue Transplantation

OBJECTIVEThis study aimed to explore the main features and advantages of the muscle pedicled platysma myocutaneous flap (PMF), the degree of improvement of flap harvest. To evaluate the application value of the flap in the reconstruction of buccal mucosa carcinoma defects.

METHODSTwenty-three patients received PMF with MacFee incision to reconstruct buccal mucosa defects that were caused by the resection of precancer lesions and benign and malignant tumors from August 2012 to April 2015. When elevating the cervical skin from the platysma, most of the subcutaneous tissue was preserved on the muscle. The continuity of the facial vessels was retained. The external jugular vein was preserved on the reverse side of the platysma.

RESULTSTwenty-one flaps survived completely, whereas the other two flaps presented partial skin loss. Two patients showed disturbed wound healing in the neck. Secondary healing was achieved after attentive wound care. All patients were followed up from 11 to 43 months. The function of the recipient sites recovered well. Except for the two patients with large-area scarring in the neck, the remaining cases presented satisfactory neck contours. No relapses were observed during the follow-up period.

CONCLUSIONSCompared with the traditional PMF, the muscle pedicled PMF provides a larger skin paddle and presents a better aesthetic and functional effect. Thus, this approach is a novel and ideal option for the restoration of buccal mucosa defects.

Face ; Humans ; Mouth Mucosa ; Mouth Neoplasms ; surgery ; Myocutaneous Flap ; Neck ; Neck Muscles ; Neoplasm Recurrence, Local ; Postoperative Complications ; Reconstructive Surgical Procedures ; Surgical Flaps

Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for ante- rolateral thigh (ALT) flap. Oblique branch of LCFA is an alternative pedicle that can be used in micro- vascular surgery. According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction. Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident, who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.
Accidents, Traffic ; Buttocks ; Femoral Artery ; surgery ; transplantation ; Femur ; Graft Survival ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Myocutaneous Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; methods ; Risk Assessment ; Soft Tissue Injuries ; diagnosis ; surgery ; Surgical Flaps ; blood supply ; transplantation ; Thigh ; surgery ; Wound Healing ; physiology

OBJECTIVETo examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.

METHODSPatients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.

RESULTSAmong the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).

CONCLUSIONAnterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.

Free Tissue Flaps ; Humans ; Maxillofacial Abnormalities ; surgery ; Myocutaneous Flap ; Necrosis ; Quality of Life ; Reconstructive Surgical Procedures ; methods ; statistics & numerical data ; Surgery, Oral ; Thigh ; Wound Healing