Reverse-supercharged, distally based latissimus dorsi flap for lumbar defect

A case report

Ryusho Hamada, Akira Shinaoka, Toshiyuki Watanabe, Humiaki Yasui, Yoshihiro Kimata

Research output: Contribution to journalArticle

Abstract

Well-vascularized tissue is required for successful reconstruction of a soft tissue defect in the lumbar region. There are several options for reconstruction; however, controversy exists regarding the optimal technique. Here, we present a case of a lumbar defect following tumor resection in a 75-year-old patient that was repaired using a reverse-supercharged, distally based latissimus dorsi flap. The defect of size 15 × 12 cm 2 was localized to the lumbar region. An 11 × 7 cm 2 -sized, distally based latissimus dorsi flap was designed cephalad to the latissimus dorsi muscle. After the flap was tunneled to the defect, vascular insufficiency of the skin flap was observed. Supercharging was subsequently performed by anastomosing the serratus anterior branch in a reverse manner to the lumbar perforator. The diameters of the vessels at the end-to-end anastomosis site were 1.0 mm (artery) and 1.2 mm (vein), respectively, and there was slight discrepancy in their calibers. After microvascular anastomosis, the vascular supply of the flap improved, and the flap survived uneventfully, without venous congestion. The patient was discharged 17 days after the surgery, and no recurrence of the tumor was observed at the 2-year follow-up. We report a case of successful salvage of a distally based latissimus dorsi flap by the reverse-supercharge technique based on a serratus anterior branch. This flap might be a suitable alternative for use in the lumbar region in the case of limited availability of reconstructive choices.

Original languageEnglish
JournalMicrosurgery
DOIs
Publication statusPublished - Jan 1 2019

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Superficial Back Muscles
Lumbosacral Region
Blood Vessels
Hyperemia
Ambulatory Surgical Procedures
Veins
Neoplasms
Arteries
Recurrence
Muscles
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Reverse-supercharged, distally based latissimus dorsi flap for lumbar defect: A case report",
abstract = "Well-vascularized tissue is required for successful reconstruction of a soft tissue defect in the lumbar region. There are several options for reconstruction; however, controversy exists regarding the optimal technique. Here, we present a case of a lumbar defect following tumor resection in a 75-year-old patient that was repaired using a reverse-supercharged, distally based latissimus dorsi flap. The defect of size 15 × 12 cm 2 was localized to the lumbar region. An 11 × 7 cm 2 -sized, distally based latissimus dorsi flap was designed cephalad to the latissimus dorsi muscle. After the flap was tunneled to the defect, vascular insufficiency of the skin flap was observed. Supercharging was subsequently performed by anastomosing the serratus anterior branch in a reverse manner to the lumbar perforator. The diameters of the vessels at the end-to-end anastomosis site were 1.0 mm (artery) and 1.2 mm (vein), respectively, and there was slight discrepancy in their calibers. After microvascular anastomosis, the vascular supply of the flap improved, and the flap survived uneventfully, without venous congestion. The patient was discharged 17 days after the surgery, and no recurrence of the tumor was observed at the 2-year follow-up. We report a case of successful salvage of a distally based latissimus dorsi flap by the reverse-supercharge technique based on a serratus anterior branch. This flap might be a suitable alternative for use in the lumbar region in the case of limited availability of reconstructive choices.",
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