LATISSIMUS-DORSI FREE-FLAP IN ORTHOPEDIC RECONSTRUCTIVE SURGERY

In complex musculoskeletal diseases, soft-tissue reconstruction is usu ally the key to a good clinical result. Selection of an ideal flap is a critical step in successful reconstruction. We performed latissimus dorsi free flap transfers in 52 patients with orthopedic disorders fro m 1988 to 1993. Recipient sites were the lower extremities (44), upper extremities (six) and buttocks (two). The indications for flap surger y comprised chronic ulcer (seven), osteomyelitis (nine), compound frac tures (28), crushing or avulsion injuries (six) and malignancy (two). rill of the flaps survived ed and the therapeutic goals were satisfact orily achieved. One patient had revision of vascular anastomosis and f ive patients underwent skin regrafting. Of eight patients who complain ed of bulkiness of the flap, only two patients had debulking surgery. No chronic infection occurred in either skeletal or soft tissue after flap coverage in any patients. Two of five heel flaps had initial ulce rs and became endurable after one year. Two patients with malignancy w ere treated with wide resection and coverage with the flap. The esthet ic and functional morbidity of the donor site was minimal. Through sev eral modifications - segmentalization, tailoring, thinning and multipl e islanding - the flaps become so versatile that they can be applied t o different kinds of tissue defects in different locations of the body . This series of patients revealed the flap to be the most useful arma ment in the reconstruction of complex musculoskeletal diseases, partic ularly for orthopedic microsurgeons.