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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(04): 351-356
DOI: 10.1055/s-0042-1759497
Original Article

Dual Venous Drainage for the Free Latissimus Dorsi Muscle Flap—Using the Serratus Vein Tributary—Making Virtue of a Necessity

Parvati Ravula
1   Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences Punjagutta, Hyderabad, Telangana, India
,
Venkata Koteswararao Rayidi 
1   Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences Punjagutta, Hyderabad, Telangana, India
,
Roopesh Kumar Nambi Muni
2   Department of Plastic Surgery, ESI Medical College and Hospital, Hyderabad, Telangana, India
,
Srikanth Rangachari
1   Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences Punjagutta, Hyderabad, Telangana, India
,
Asha Deepthi Bathini 
1   Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences Punjagutta, Hyderabad, Telangana, India
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Abstract

Background Most flap failures in the lower limb are on account of venous congestion. Literature shows a decrease in the incidence of venous failure when two veins are anastomosed. The thoracodorsal pedicle of the latissimus dorsi free flap affords the possibility of a single venous anastomosis. The lack of a second venous outflow could result in venous congestion in the distal limits of the flap, particularly when long flaps are required for large defects or when the recipient veins are smaller in diameter.

Methods We describe a consecutive series of 11 cases of latissimus dorsi flaps for leg and foot defects with a mean defect size of 310 cm2, where the serratus anterior vein was used as a second venous outflow channel to ensure maximal venous drainage.

Results There were no re-explorations for anastomotic causes. Only one case had partial distal muscle necrosis. There was a delayed anastomotic blowout due to infection resulting in amputation in one case. There was no partial distal muscle necrosis in nine of the ten cases.

Conclusion Using the serratus vein as a second venous outflow is of use in reducing incidence of venous occlusion and distal muscle necrosis and can be specially indicated for large flaps and venous diameter discrepancy.

Keywords

free latissimus dorsi muscle flap - venous congestion - lower limb trauma - serratus vein - second venous anastomosis


Publication History

Article published online:
22 December 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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