Arch Hand Microsurg.  2025 Mar;30(1):66-73. 10.12790/ahm.24.0064.

Latissimus dorsi and omental free flap reconstruction of a large buttock soft-tissue defect using the lateral circumflex femoral artery descending branch as the recipient vessel: a case report

• Lee S
• Eun S

• KMID: 2565470
• DOI: http://doi.org/10.12790/ahm.24.0064

Abstract

Large defects in the buttock region are uncommon and pose significant challenges for reconstruction. The skin in this area adheres firmly to the subcutaneous tissue, making mobilization difficult. Attempts to use local or regional flaps to cover defects in this region often result in flap necrosis, leading to an elevated risk of infection and unstable wounds. In addition to these intrinsic challenges, factors such as fecal contamination, difficulty in patient positioning, and suboptimal underlying patient conditions further complicate the reconstruction process. Furthermore, the lack of suitable recipient vessels often hinders free tissue transfer for complex wound coverage in the buttock area. Here, we present a case involving sequential latissimus dorsi and omental free flap coverage to address a large gluteal skin and soft-tissue defect. Our experience highlights the importance of meticulous reconstructive planning and the appropriate selection of recipient vessels for successful buttock reconstruction.

Keyword

Free tissue flaps; Buttocks; Superficial back muscles; Omentum

Figure

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  Fig. 1. Preoperative photograph of the patient, who had previously undergone free latissimus dorsi myocutaneous flap reconstruction at an outside hospital. Necrotic tissue is observed in the right buttock area, with unviable tissue remaining in the left buttock site.

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  Fig. 2. Intraoperative photographs showing the patient before and after debridement of the necrotic flap.

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  Fig. 3. Identification of the recipient vessel from the descending branches of the left lateral circumflex femoral artery (LCFA) in the prone position. The LCFA vessel was delivered to the gluteal wound via a subcutaneous tunnel.

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  Fig. 4. Design and harvesting of the left-sided latissimus dorsi myocutaneous flap.

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  Fig. 5. Immediate postoperative photo of the flap, demonstrating good blood flow.

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  Fig. 6. Postoperative photo taken 2 months after surgery.

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  Fig. 7. Three months postoperatively, a large fistula developed at the upper site of the flap, and a rotation flap closure was performed.

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  Fig. 8. A fistulous tract developed at the upper margin of the flap, and surgical debridement was performed.

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  Fig. 9. Harvested omental flap, inset with gastroepiploic pedicle on the right side.

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  Fig. 10. Microvascular anastomosis between the omental vessel and the right-side lateral circumflex femoral artery descending branch. Immediate view after skin closure.

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  Fig. 11. Nine-year follow-up photo showing a favorable result with no complications.

Reference

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