Arch Hand Microsurg.  2022 Dec;27(4):359-363. 10.12790/ahm.22.0063.

Reconstruction of a high-energy penetrating injury from the abdomen to the sacral area using a latissimus dorsi free flap with monofilament polypropylene mesh and pedicled flap rotation: a case report

  • 1Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea


A 50-year-old man was transferred to a level I trauma center for penetrating injury. Industrial metal had penetrated his trunk, and he was injured in internal organs. The injured internal organs were treated by the trauma surgery team. The peritoneum was reconstructed with artificial dermal matrix graft. The wound was managed with negative-pressure wound therapy, and several debridement procedures were performed. The full-thickness abdominal defect was covered with monofilament polypropylene mesh(Parietene mesh, 30×30 cm). A latissimus dorsi flap was elevated with a musculocutaneous flap measured 50×30 cm, and 6-cm thoracodorsal artery pedicle. Microvascular anastomosis was performed using the thoracodorsal and left femoral arteries. Two weeks later, we performed local flap rotation based on gluteal artery perforator in the sacral area. Polypropylene mesh was successfully inserted without complications. Combining a latissimus dorsi free flap on a polypropylene mesh can be an effective method for reconstructing large penetrating wounds on the trunk.


Penetrating injury; Latissimus dorsi free flap; Free tissue transfer; Monofilament polypropylene mesh


  • Fig. 1. Initial status of the patient upon arrival at the trauma bay after a penetrating injury by a compressing machine.

  • Fig. 2. Wounds after 2 weeks of multiple wound perfusion and debridement. (A) Abdominal side. (B) Sacral side.

  • Fig. 3. Abdominal wound applied with acellular dermal matrix for maintenance of the intestinal injury recovery and temporary intestinal coverage.

  • Fig. 4. Abdominal wound repaired with mesh and latissimus dorsi musculocutaneous flap with monofilament polypropylene mesh coverage. (A) Wounds with monofilament polypropylene mesh applied. (B, C) Elevated latissimus dorsi musculocutaneous flap. Yellow arrows indicate the thoracodorsal artery.

  • Fig. 5. Image at 2 months postoperatively. (A) Abdominal side. (B) Sacral side.



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