Arch Hand Microsurg.  2023 Jun;28(2):110-113. 10.12790/ahm.23.0008.

Reconstruction of an abdominal wall defect using a latissimus dorsi musculocutaneous free flap after high-intensity focused ultrasound: a case report

• Kim DK
• Kim YH

• KMID: 2542562
• DOI: http://doi.org/10.12790/ahm.23.0008

Abstract

High-intensity focused ultrasound (HIFU) ablation is a safe and effective minimally invasive option for treating uterine fibromas, but it can cause complications such as abdominal wall defects. Reconstruction of such defects can be challenging, but a latissimus dorsi musculocutaneous free flap can be used to restore the integrity of the myofascial layer and provide external cutaneous coverage. Herein, we present a case report of a 37-year-old woman who underwent HIFU for an 8-cm uterine fibroma and subsequently developed a large abdominal wall defect with necrosis of the rectus muscle. The latissimus dorsi musculocutaneous free flap was used to reconstruct the rectus muscle and cover the abdominal soft tissue, resulting in successful engraftment without complications. We present our experience using a latissimus dorsi musculocutaneous free flap to reconstruct a large HIFU-induced composite defect in the abdominal wall.

Keyword

Abdominal wall defect; Latissimus dorsi free flap; Musculocutaneous flap

Figure

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  Fig. 1. (A) After debridement of necrotic and unviable tissue, the abdominal wall fascia defect measured about 20×15 cm and the soft tissue defect measured roughly 15×5 cm with loss of the rectus abdominis muscle about 2/3 from the origin. (B) An approximately 20×15-cm latissimus dorsi musculocutaneous flap was harvested with a 10 cm-long pedicle in the right axillary area. (C) The myofascial defect was repaired by latissimus dorsi muscle and fascia with anastomosis to the left deep inferior epigastric vessels. A 15×5-cm skin flap was de-epithelized to cover the soft tissue defect, and the remaining skin flap was used to be monitoring flap.

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  Fig. 2. A follow-up computed tomography scan taken 2 weeks later. Although part of the flap exhibited fatty degeneration (yellow arrow), the latissimus dorsi musculocutaneous free flap was inset well overall in the defect area in the abdomen.

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  Fig. 3. (A) Long-term follow-up view showed good coverage, with a mild hypertrophic scar. (B) One year after the free flap operation, scar revision was done with detachment of the monitoring flap.

Reference

References

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