Technical modifications of the latissimus dorsi pedicled flap to increase versatility and viability

Objective: Describe the elevation and insetting of the pedicled latissimus dorsi musculocutaneous Bap, Review history of this flap's evolution and per sonal series of 68 consecutive cases since 1984, Study Design: Retrospectiv e review. Setting: Tertiary, referral, academic center. Methods: Retrospect ive review of 68 consecutive patient records in which the pedicled latissim us dorsi musculocutaneous flap was used to reconstruct head and neck defect s, Overall flap survival and postoperative complications were used as outco me measures. Results: Thirty-one women and 37 men underwent reconstruction with the latissimus dorsi pedicled flap between 1984 to 1998, The mean age was 61 years. Sixty-three cases followed poston-cologic ablation and 5 case s addressed traumatic tissue loss. Forty-three patients had prior radiother apy and 26 patients had undergone prior reconstructive surgery. The overall nap survival rate was 67/68 (98.5%), with one case of complete nap necrosi s, Six cases of partial flap necrosis occurred. There were 8 other minor co mplications including fistula, wound dehiscence, hematoma and cerebrospinal fluid accumulation. Fifty-six donor sites were closed primarily resulting in 2 dehiscences and 17 seromatas, Three of 12 skin grafts to the donor sit es were compromised, Conclusion: The excellent flap survival rate (98.5%) i s the result of proper patient selection and adherence to three technical f undamentals: skin paddle design, pedicle dissection, and pedicle stabilizat ion, The minimal donor site morbidity also demonstrated in this series supp orts the continued use of the latissimus dorsi pedicled nap for reconstruct ion of head and neck defects.