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CC BY-NC-ND 4.0 · Indian J Plast Surg 2018; 51(01): 024-032
DOI: 10.4103/ijps.IJPS_121_17
Original Article
Association of Plastic Surgeons of India

A retrospective analysis of latissimus dorsi–serratus anterior chimeric flap reconstruction in 47 patients with extensive lower extremity trauma

Ravi Kumar Mahajan
Department of Plastic and Reconstructive Surgery, GT Road, Model Town, Amritsar 143001, Punjab, India
,
Krishnan Srinivasan
Department of Plastic and Reconstructive Surgery, GT Road, Model Town, Amritsar 143001, Punjab, India
,
Abhiskek Bhamre
Department of Plastic and Reconstructive Surgery, GT Road, Model Town, Amritsar 143001, Punjab, India
,
Mahipal Singh
Department of Plastic and Reconstructive Surgery, GT Road, Model Town, Amritsar 143001, Punjab, India
,
Prakash Kumar
Department of Plastic and Reconstructive Surgery, GT Road, Model Town, Amritsar 143001, Punjab, India
,
Ankush Tambotra
1   Department of Amandeep Hospital and Clinics, GT Road, Model Town, Amritsar 143001, Punjab, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 July 2019 (online)

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ABSTRACT

Background: Many flaps have been described for reconstruction of lower extremity defects, including, Latissimus Dorsi, Rectus abdominis, Anterolateral thigh perforator flaps, each having advantages and disadvantages. The defect location, size and specific geometric pattern of defect influences the type of flap that can be used. In this case series, we describe the specific situations where the use of chimeric latissimus dorsi–serratus anterior (LD + SA) free flaps are of advantage in providing complete wound cover. Materials and Methods: Case records of all patients who underwent LD + SA free flap transfer for lower extremity trauma at Amandeep Hospital, from Feb 2006 to Feb 2017 were reviewed. Patients were categorised based on the anatomical location and size of defect. The method of usage of the chimeric segments, recipient vessels and type of anastomosis were noted. Flap complications, if any were reviewed. Result: 47 patients with lower limb defects were included in the study. All cases were post traumatic in nature. Defect size ranged from 180 sq cm to 1050 sq cm. Average defect size was 487.70 sq cm. All patients underwent soft tissue reconstruction with LD + SA flap. Complete wound cover was obtained. Conclusion: Latissimus dorsi + Serratus anterior free tissue transfer is an effective, reliable method of providing cover to extensive lower limb traumatic defects with minimal donor site morbidity, with added freedom of inset and flap positioning. Specific use is seen in patients with broad proximal defect, long defect in the leg, defects involving adjacent anatomical areas and in large defect with dead space.

KEY WORDS

Chimeric flap - latissimus dorsi - lower limb reconstruction - serratus anterior - trauma
 

  • REFERENCES

  • 1 Gururaj G. Road traffic deaths, injuries and disabilities in India: Current scenario. Natl Med J India 2008; 21: 14-20
    PubMedGoogle Scholar
  • 2 Wong CH, Ong YS, Wei FC. The anterolateral thigh – Vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg 2012; 65: 235-9
    CrossrefPubMedGoogle Scholar
  • 3 Kim SW, Youn S, Kim JD, Kim JT, Hwang KT, Kim YH. et al. Reconstruction of extensive lower limb defects with thoracodorsal axis chimeric flaps. Plast Reconstr Surg 2013; 132: 470-9
    CrossrefPubMedGoogle Scholar
  • 4 Serafin D. editor. The latissimus dorsi muscle-musculocutaneous flap. Atlas of Microsurgical Tissue Transplantation. 1st ed.. United States of America; W.B. Saunders: 1996: 205-20
    Google Scholar
  • 5 Serafin D. editor. The serratus anterior muscle-musculocutaneous flap. In: Atlas of Microsurgical Tissue Transplantation. 1st ed.. United States of America; W.B. Saunders: 1990: 191-204
    Google Scholar
  • 6 Collini FJ, Wood MB. The use of combined latissimus serratus free flap for soft tissue coverage in hand. Eur J Plast Surg 1989; 12: 179-82
    CrossrefGoogle Scholar
  • 7 Musharafieh R, Macari G, Hayek S, Elhassan B, Atiyeh B. Rectus abdominis free-tissue transfer in lower extremity reconstruction: Review of 40 cases. J Reconstr Microsurg 2000; 16: 341-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap. J Plast Reconstr Aesthet Surg 2012; 65: e42-5
    CrossrefPubMedGoogle Scholar
  • 9 Hallock GG. The combined parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap. Plast Reconstr Surg 2008; 121: 101-7
    CrossrefPubMedGoogle Scholar
  • 10 Chao AH, Coriddi M, Miller MJ. Reconstruction of extensive defects with combined transverse-vertical rectus abdominis (cruciate) myocutaneous flaps. Plast Reconstr Surg 2014; 133: 442e-3e
    CrossrefPubMedGoogle Scholar
  • 11 Dinner MI, Labandter H, Dowden RV. Rectus abdominis musculocutaneous flap. In: Strauch B, Vasconez L, Hall-Findlay EJ, Lee BT. editors. Grabb's Encyclopedia of Flaps. 1st ed.. Boston Toronto London: Little, Brown and Company; 1990: 1370-2
    Google Scholar
  • 12 Podrecca S, Tomic O, Salvatori P, Riggio E. Free composite osseomyocutaneous flap of latissimus dorsi, serratus anterior and rib for oromandibular recon. Eur J Plast Surg 2000; 23: 316-20
    CrossrefGoogle Scholar
  • 13 Girod A, Nadaud F, Mosseri V, Jouffroy T, Rodriguez J. Use of chimeric subscapular artery system free flaps for soft-tissue reconstruction of the oral cavity and oropharynx: Advantages and donor-site morbidity. Plast Reconstr Surg 2009; 124: 445e-6e
    CrossrefPubMedGoogle Scholar
  • 14 Harii K, Yamada A, Ishihara K, Miki Y, Itoh M. A free transfer of both latissimus dorsi and serratus anterior flaps with thorcodorsal vessel anastomosis. Plast Reconstr Surg 1982; 70: 620-9
    CrossrefPubMedGoogle Scholar
  • 15 Takayanagi S, Ohtsuka M, Tsukie T. Use of the latissimus dorsi and the serratus anterior muscles as a combined flap. Ann Plast Surg 1988; 20: 333-9
    CrossrefPubMedGoogle Scholar
  • 16 Koul AR, Nahar S, Prabhu J, Kale SM, Kumar PH. Free Boomerang-Shaped Extended Rectus Abdominis Myocutaneous flap: The longest possible skin/myocutaneous free flap for soft tissue reconstruction of extremities. Indian J Plast Surg 2011; 44: 396-404
    CrossrefPubMedGoogle Scholar
  • 17 Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg 2011; 127: 1720-9
    CrossrefPubMedGoogle Scholar
  • 18 Rausky J, Binder JP, Mazouz-Dorval S, Hamou C, Revol M. Perforator-based chimaeric thoracodorsal flap for foot reconstruction. J Plast Reconstr Aesthet Surg 2013; 66: 1798-800
    CrossrefPubMedGoogle Scholar
  • 19 Hussain ON, Sabbagh MD, Carlsen BT. Complex microsurgical reconstruction after tumor resection in the trunk and extremities. Clin Plast Surg 2017; 44: 299-311
    CrossrefPubMedGoogle Scholar
  • 20 Kiyokawa K, Tanaka S, Kiduka Y, Inoue Y, Yamauchi T, Tai Y. et al. Reconstruction of the form and function of lateral malleolus and ankle joint. J Reconstr Microsurg 2005; 21: 371-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Mathes SJ, Hansen SL. Flap classification and its application. In: Mathes SJ, Hentz VR. editors. Plastic Surgery. 2nd ed.. Vol. 1. United States of America; Saunders: 2006: 373-5
    Google Scholar
  • 22 Germann G, Bickert B, Steinau HU, Wagner H, Sauerbier M. Versatility and reliability of combined flaps of the subscapular system. Plast Reconstr Surg 1999; 103: 1386-99
    CrossrefPubMedGoogle Scholar
  • 23 Park S, Han SH, Lee TJ. Algorithm for recipient vessel selection in free tissue transfer to the lower extremity. Plast Reconstr Surg 1999; 103: 1937-48
    CrossrefPubMedGoogle Scholar
  • 24 Karşıdağ S, Akçal A, Turgut G, Uğurlu K, Baş L. Lower extremity soft tissue reconstruction with free flap based on subscapular artery. Acta Orthop Traumatol Turc 2011; 45: 100-8
    CrossrefPubMedGoogle Scholar
  • 25 Soltanian H, Garcia RM, Hollenbeck ST. Current concepts in lower extremity reconstruction. Plast Reconstr Surg 2015; 136: 815e-29e
    CrossrefPubMedGoogle Scholar