Abstract
Background Over the past two decades, with the introduction of the perforator flap concept and
advances in flap dissections, lower extremities have emerged as the preferred soft
tissue flap donor sites. As a modern and high-volume microsurgical center, and the
senior author being one of the pioneers and advocates for the use of lower extremity
flap donor sites, we aim to investigate the role of latissimus dorsi (LD) free flap
in head and neck reconstruction within our current practice.
Methods All free LD flaps used for head and neck reconstruction performed by a single surgeon
between January 2010 and June 2023 were reviewed for their indications and immediate
and short-term outcomes.
Results A total of 1,586 head and neck free flap reconstructions were performed, and 33 free
LD flaps were identified. The patients' median age was 53 (interquartile range [IQR]
48.5–63.5) years. Twenty-nine (87.9%) flaps were used to reconstruct oro-maxillo-facial
and four (12.1%) flaps were used to reconstruct scalp defects. Most patients had prior
radiation (n = 28, 84.8%), neck dissection (n = 24, 72.7%), and multiple previous head and neck flap reconstructions with a median
of 3.0 (IQR 3.0–3.5) previous flaps. Six (18.2%) LD flaps were used to replace failed
flaps from other donor sites. No major complications such as total flap failure or
takebacks, and no need for vein grafts but three (9.1%) had flap marginal necrosis.
Other complications included one flap dehiscence (3.0%), one orocutaneous fistula
(3.0%), two wound infections (6.1%), three plate exposures (9.1%), and three patients
who developed local recurrence (9.1%). The median patient follow-up time was 16 (IQR
5–27) months.
Conclusion This retrospective study demonstrates the role of LD free flap in head and neck reconstruction
as a reliable and versatile backup soft tissue flap when workhorse flaps from lower
extremity donor sites are either unavailable or unsuitable.
Keywords
latissimus dorsi free flap - head and neck reconstruction - microsurgical free flap
- recurrent head and neck cancers
