Free latissimus dorsi muscle-chimeric thoracodorsal artery perforator flaps for reconstruction of complicated defects: does muscle still have a place in the domain of perforator flaps?

Abstract

The reconstruction of complicated defects with 3-dimensional deficits remains challenging. The reconstruction of these defects requires not only coverage of surface but also appropriate obliteration of dead space, and muscle-chimeric perforator flaps can be a valuable option. Here, we present our experience with free latissimus dorsi (LD) muscle-chimeric thoracodorsal artery perforator (TDAP) flaps for the treatment of complicated defects. A retrospective chart review was performed for patients who underwent a free LD muscle-chimeric TDAP flap procedure for the treatment of complicated wounds with 3-dimensional tissue deficits between March 2005 and October 2012. The surgical technique, clinical outcomes, and postoperative complications were evaluated. A total of 24 cases were included. All flaps survived and no partial flap losses were encountered. Large skin flaps of 115 cm average size were elevated, with an average of 38-cm muscle segments. The total length of pedicle was 12.2 cm on average, with 7.3 cm of common pedicle, 4.9 cm of skin paddle, and 3.4 cm of muscle segments. Muscle segments could be inset in the underlying dead space with spatial freedom. The mean follow-up period was 34.1 months. Wounds successfully healed in all cases without significant postoperative complications. The donor-site complication rate of the chimeric flap group was similar to that of the simple TDAP group. The use of LD muscle-chimeric TDAP flaps with Y-pedicle configurations allowed efficient positioning of both skin and muscle components for their specific purposes and successful healing of complicated wounds. The muscle components of chimeric flaps acted as "filler flaps" and were an effective addition to the perforator flap technique for the reconstruction of complicated defects without the addition of significant donor-site morbidity.