Arch Hand Microsurg.  2019 Jun;24(2):177-182. 10.12790/ahm.2019.24.2.177.

Free Latismus Dorsi Muscle Flap with a Flow-Through Technique for Lower Limb Salvage

• Ayad WM
• Mohammed A
• Ismail HM
• Ouf MO
• Elbatawy A

• KMID: 2448052
• DOI: http://doi.org/10.12790/ahm.2019.24.2.177

Abstract

PURPOSE
The lower limb injuries still one of the devastating problems in surgical practice. Complex defects may affect one major vessel that supplies the distal portion of the leg and foot. The use of the flow-through technique is a very useful tool for sure vascularization of the flap and revascularization of the distal limb at the same time. The aim of this study was to evaluate the advantages of the use of the flow-through technique for lower limb reconstruction.
METHODS
This retrospective study was including 15 patients complaining of post-traumatic leg and/or foot defects. Free latissimus muscle transfer with the flow-through technique was done for lower limb reconstruction. The subscapular artery was anastomosed to the proximal segment of the limb vessel and the circumflex scapular artery anastomosed to the distal segment of the limb vessel. Follow-up was for six months.
RESULTS
Patients were followed for 6 months. All flaps were survived and there were no anastomotic complications.
CONCLUSION
The use of the flow-through technique is a very useful tool for vascularization of the flap and revascularization of the distal limb at the same time.

Keyword

Free tissue transfer flaps; Lower limb; Reconstructive surgical procedure; Microsurgical free flap

MeSH Terms

Arteries
Equipment and Supplies
Extremities
Follow-Up Studies
Foot
Free Tissue Flaps
Humans
Leg
Lower Extremity*
Reconstructive Surgical Procedures
Retrospective Studies

Figure

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  Fig. 1. A case of free tissue transfer for left leg. A patient who was reconstructed by chimeric flap flow-through technique for coverage of posttraumatic soft tissue loss of the lower third of the left leg. (A) Preoperative photograph. Demonstrates soft tissue loss of the lower third of the leg with the exposed fibula. (B) Debridement and excision of all devitalized tissues. (C) Design of the chimeric myocutaneuos flap. (D) Chimeric flap after separation.

• 

  Fig. 2. A case of free tissue transfer for left leg. A patient who was reconstructed by chimeric flap flow-through technique for coverage of posttraumatic soft tissue loss of the lower third of the left leg. (A) Anterior tibial vessels prepa-ration for anastomosis. (B) After anastomosis. (C) Diagram showing the vessels were anastomosed. (D) A photograph at follow-up on postoperative year 2.

• 

  Fig. 3. A case of free latissimus myocutaneuos flap transfer. A male patient was reconstructed by free latissimus myocutaneuos flap transfer for salvage of the left leg. (A) Preoperative photograph. (B) Preoperative marking of the flap. (C) Latissimus myocutaneuos flap after separation. (D) An immediate postoperative photograph.

• 

  Fig. 4. A case of heel reconstruction. A patient with unstable, adherent scar overlying the right heel. The patient was reconstructed by free latissimus myocutaneuos flap transfer. (A) Preoperative photograph. (B) A photograph at follow-up on postoperative year 1.

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