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Kumar et al. Reverse latissimus dorsi muscle flap for back

Figure 3: Case 1. Myelomeneingocle defect, after release of Figure 4: Case 3. Reverse latissimus dorsi muscle flap and gluteus
teethered cords muscle flap to cover the myelomeningocele defect

The skin adjacent to the defect was advanced to close cancer excision and 3 patients had myelomeningocele
the defect. She developed CSF leak manifesting as correction. Four patients underwent turnover of
swelling in the operated site and also excess drainage the reverse latissimus dorsi flap and 1 patient had
collection. She was reexplored to correct the CSF transposition of the reverse latissimus dorsi flap.
leak. The dura was reinforced with sutures and glue. All 4 reverse latissimus dorsi turnover muscle flap
The reverse latissimus dorsi turnover flaps were used were done by a single surgeon and the reverse
to cover this complicated myelomeningocele defect. latissimus dorsi muscle transposition flap was done by
Here, the distal end of the latissimus dorsi flap was not another surgeon. Four patients had advancement of
showing adequate vascularity and was debrided. This fasciocutaneous flaps over the muscle flap; 1 patient
flap was able to cover only the upper two thirds of the had a split thickness skin graft over the muscle.
defect. A contralateral gluteus maximus muscle flap
was advanced to the lower part of the defect [Figure 4]. The indications for the use of a muscle flap in these
The skin was advanced to cover the defect. The wound cases were CSF leak, sinus, wound dehiscence, need
healed well with no complications. for vascular cover over the implants, obliteration of the
dead space, and to reconstruct the chest wall defect.
RESULTS
Two patients had prior surgery within a week before
A total of 5 patients [Table 1] were treated with a the reverse latissimus dorsi flap was used to cover the
reverse latissimus dorsi flap for various defects of defect. Three patients had not undergone prior surgery.
the back. Among these 5 patients, 2 were male and 3
were female. Three patients aged below 2 years and 2 In case 3, the distal muscle did not look healthy; hence
patients aged 55 years and 60 years. Two patients had the contralateral gluteus maximus flap was raised

Table 1: All the cases included in the study
Age/ Muscle flap used and Complications after
No. gender Diagnosis Indication Defect size movement of flap the surgery
1 9 days/ Lumbosacral Associated with hydrocephalus, 10 cm × 8 cm RLDMF turnover Skin edge necrosis
male myelomeningocele had a ventriculo-peritoneal shunt, lumbosacral of 1 cm, was allowed
high suspicion of chance of CSF defect to heal by secondary
leak from the dural patch intention
2 14 Lumbosacral Operated 4 days before, developed 12 cm × 5 cm RLDMF turnover Nil
months/ myelomeningocele CSF leak lumbosacral
male defect
3 12 Lumbosacral Operated 1 week before and 14 cm × 6 cm RLDMF turnover and Nil
months/ myelomeningocele developed CSF leak lumbosacral GMMF
female defect
4 55 years/ Recurrent sacral Cross linking of left and right iliac 15 cm × 20 cm RLDMF turnover and Nil
female chordoma of sacral bones with the lumbar bones using lumbosacral FCRF
and lumbar vertebrae pedicle screws after sacrectomy defect
5 61 years/ Spindle cell tumor Excision included posterior chest 12 cm × 10 cm RLDMF transposition Excision margins were
female of lung and lower wall and lower lobe of lung thoracic defect positive for malignancy
posterior chest wall and patient declined
further intervention
CSF: cerebrospinal fluid; RLDMF: reverse latissimus dorsi muscle flap; GMMF: gluteus maximus muscle flap; FCRF: fasciocuatneous
rotation flap
78 Plastic and Aesthetic Research ¦ Volume 4 ¦ May 26, 2017