Page 87 - Read Online

Kumar et al. Reverse latissimus dorsi muscle flap for back

not have the mopping qualities of the muscle. We can Concept design: K.M. Kumar
deepithelialise the skin flaps and use it to obliterate Literature search: K.M. Kumar
the dead space. This may lead to the development of Case material’s provide: K.M. Kumar, S.K. Shivalingappa
epithelial cysts. Söyüncü et al. have used latissimus
[9]
dorsi muscle flap along with omentum with a view that Financial support and sponsorship
layered closure would decrease chances of CSF leak None.
in recurrent cases of CSF leak.
Conflicts of interest
Free flaps are an option, however the recipient vessels
are deep and hard to find. The vessels which could There are no conflicts of interest.
be harvested as recipient are the superior gluteal
vessels, inferior gluteal vessels, and intercostal Patient consent
vessels, perforators from the deep femoral system, [15] Obtained.
superficial femoral trunk, and thoracodorsal vessels.
The other possible methods of obtaining a recipient Ethics approval
are using an interposition vein graft between the Obtained.
distant vessels to the donor vessels, [16] or a carrier
vessel may be used and flap transferred in stages. REFERENCES
Reverse latissimus dorsi flap has been transferred to
the defect and supercharged the flap by anastomosing 1. Shaw WW, Aston SJ, Zide BM. Reconstruction of the Trunk. In:
the thoracodorsal vessels with the inferior gluteal McCarthy JG. Plastic Surgery vol 6. The trunk and lower extremity.
vessels. [17] Philadelphia: W.B. Saunders Company; 1990. p. 3675-796.
2. Mathes SJ, Nahai F. Latissimus dorsiflap. In: Mathes SJ, Nahai F.
We have followed up the patients for 6 months; the Reconstructive Surgery Principles, Anatomy and Technique. New
York: Churchill Liningstone; 1997. p. 565-615.
functional deficit of the shoulder could not be assessed 3. Sydorak RM, Hoffman W, Lee H, Yingling CD, Longaker M, Chang
in children. However there was no appreciable J, Smith B, Harrison MR, Albanese CT. Reverse latissimus dorsi
difference in movement of the shoulder when compared muscle flap for repair of congenital diaphragmatic hernia. J Pediatr
to the opposite shoulder. In case 4, we did not find any Surg 2003;38:296-300.
restriction when compared to the opposite shoulder. 4. Ayad W, Zayed EF, Refaae AS, Taman EA, Elewa S. The versatility
Case 5 was lost in follow up. Other studies regarding of reversed turn over latissimus dorsi muscle flap for reconstruction of
functional assessment have also found no significant meningomyelocele defects. Egypt J Plast Reconstr Surg 2012;36:33-
shoulder function disability. [18,19] 9.
5. Rajput DU, Muniswamy SB. Reverse latissimus dorsi turnover muscle
flap for coverage of secondary midline lumbar defect following spinal
Our study had 5 cases; it is not a comparative study. surgery. J Spinal Surg 2016;3:12-4.
Further studies may be required to compare other 6. Yoo CM, Kang DH, Hwang SH, Park KB. Reverse latissimus dorsi
flaps with the reverse latissimus dorsi flap to establish muscle flap for an extensive soft tissue defect accompanied by
that it is a better choice in complex defects of the back. infectious spondylitis. J Korean Neuro Surg Soc 2012;52:423-6.
However, most of the authors in the literature have 7. Zakaria Y, Hasan EA. Reversed turnover latissimus dorsi muscle flap
agreed that reverse latissimus dorsi flap is a choice for closure of myelomeningocele defects. J Plast Reconstr Aesthet
for reconstruction of the back with CSF leaks, difficult 8. Surg 2010;63:1513-8.
Kotti B, Jaidane O, Ben Hassouna J, Rahal K. The “reverse”
wounds with infection, radiation, etc. latissimus dorsi flap for large lower lumbar defect. Case Rep Surg
2012;2012:964625.
In conclusion, we feel that reverse latissimus dorsi 9. Söyüncü Y, Bigat Z, Söyüncü İ, Özkan Ö. Omentum and reverse
muscle flap is a robust flap with reach up to the lower turnover latissimus dorsi musculocutaneous flap for the treatment of
part of sacrum. We recommend it as a definite choice cerebrospinal fluid fistula. Acta Orthop Traumatol Turc 2015;49:571-
for big complicated meningomyelocele defect or any 5.
posterior defect in the lumbar and sacral region. We 10. de Fontaine S, Gaede F, Berthe JV. The reverse turnover latissimus
feel that this flap may be considered as a primary dorsi flap for clsure of midline lumbar defects. J Plast Reconstr
Aesthet Surg 2008;61:917-24.
choice for big myelomeningocele defect. This needs 11. Stevenson TR, Rohrich RJ, Pollock RA, Dingman RO, Bostwick
further studies. J 3rd. More experience with the “reverse” latissimus dorsi
musculocutaneous flap: precise location of blood supply. Plast
Authors’ contributions Reconstr Surg 1984;74:237-43.
Manuscript’s preparation: K.M. Kumar, V.P. Waiker, U.S. 12. Watanabe K, Kiyokawa K, Rikimaru H, Koga N, Yamaki K, Saga T.
anatomical study of latissimus dorsi musculocutaneous flap vascular
Odeyar distribution. J Plast Reconstr Aesthet Surg 2010;63:1091-8.
Manuscript’s review: K.M. Kumar, V.P. Waiker, U.S. 13. Hayashida K, Endo Y, Kamebuchi K. Case report reconstruction of
Odeyar exposed ilium with reverse turnover latissimus dorsi muscle flap.
80 Plastic and Aesthetic Research ¦ Volume 4 ¦ May 26, 2017