Pedicled Latissimus Dorsi Flap for Shoulder Soft-Tissue Reconstruction After Excision of a Musculoskeletal Neoplasm.

Abstract

The use of a pedicled latissimus dorsi flap for reconstruction of large soft-tissue defects following musculoskeletal tumor excision around the shoulder provides adequate well-vascularized and healthy tissue to maximize the chances of successful limb salvage and minimize the risks of wound problems and deep infection^-. Verify the adequacy of the latissimus dorsi, confirm the feasibility of the flap in relation to the extent of the defect, and use a laparotomy pad to simulate the arc of flap rotation. At the time of surgery, proper flap design and markings are critical for successful tumor excision and flap rotation. Confirm adequate tumor removal, prepare the recipient site for the flap, ensure the proper size and shape of the skin island, deepen the dissection circumferentially around the skin paddle, divide the latissimus from the thoracolumbar fascia, develop the natural plane of the flap, divide the branch for the serratus to increase rotation if necessary, and release the humeral insertion to further increase rotation if necessary. Be sure to create an adequately sized tunnel and, when passing the flap through the tunnel, to avoid tension on the vascular pedicle and the skin island. Proper postoperative care includes monitoring the flap blood supply and output of drains, removing sutures, and ensuring satisfactory healing overall. The preoperative evaluation, positioning, and preparation are identical to those for the posterior clockwise rotation technique described above. Make sure you understand the regional anatomy, ensure appropriate anterior flap rotation, and use the laparotomy pad technique to the simulate arc of rotation. The surgical principles of flap elevation and transfer are the same regardless of the location of the recipient site (see Step 3 for the posterior technique above). Elevate the flap, create a large subcutaneous tunnel for anterior transfer, and ensure optimal flap inset into the shoulder defect. Perform as for the posterior technique. In 2007, we reported on a series of 33 consecutive patients treated from 1994 to 2004 with a pedicled latissimus dorsi flap following sarcoma excision in the shoulder region.