Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel: A preliminary report

Clinical outcome of latissimus dorsi reconstruction after wide resection of soft-tissue sarcoma

BACKGROUND

We investigated the clinical outcomes of reconstruction using the latissimus dorsi (LD) flap after resection of soft-tissue sarcoma.

MATERIALS AND METHODS

We analyzed 19 patients. Free LD flap was performed in 11 patients and pedicle flap in eight patients. The mean follow-up period after the surgery was 60 months.

RESULTS

The mean age at diagnosis was 57 years. The mean tumor size was 9.8 cm. The median size of the LD flap was 140 × 100 mm. The mean surgical duration and bleeding were 510 min and 602 mL, respectively. Complications included partial skin and soft-tissue necrosis (n = 3) and wound dehiscence (n = 2). No additional free flap was not necessary for the closure of the defect due to the complications. The longer surgical duration was significantly associated with wound complications (P = 0.048). The 5-year survival rate was 80.7%, and the local recurrence-free survival rate was 89.2%. Two patients developed local recurrence, while 6 patients developed metastasis. None of the patients had any restrictions of daily life.

CONCLUSION

The LD flap after surgical tumor resection in patients with soft-tissue sarcoma was useful for the coverage of soft tissue.

[Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair]

Objective

To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair.

Methods

Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly.

Results

The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating.

Conclusion

Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.

Vascular Augmentation in Renal Transplantation: Supercharging and Turbocharging

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

Simple volume estimation of the latissimus dorsi musculocutaneous flap in Asian breast reconstruction

Breast reconstruction is surgery where aesthetics are of the utmost importance, and to achieve symmetry is the ultimate goal. Preoperative volume estimation of a transfer flap can be helpful to achieve symmetry. This study demonstrated a simple volume estimation of the latissimus dorsi musculocutaneous (LDMC) flap. It recorded each patient's body weight, height, and body mass index (BMI) and the weight of the LDMC flap in 21 cases of breast reconstruction, and examined the association between flap weight and patient body weight, height, and body mass index by linear regression analysis. Statistical association was found between flap weight and body weight and between flap weight and BMI. Linear regression analysis also revealed that the weight of the flap could be estimated from the patient's body weight and BMI.