Enhancing Viability of the Muscle-Sparing Latissimus Dorsi Flap

Yıl 2024, Cilt: 38 Sayı: 1, 19 - 31, 24.05.2024

Aydın Turan

https://doi.org/10.18614/deutip.1386328

Öz

Aim:The aim of this study is to enhance the viability of the muscle-sparing latissimus dorsi flap.
In this study, the muscle-sparing latissimus dorsi myocutaneous flap was designed with the skin paddle of the flap over the distal perforators of the thoracodorsal artery and perforators of the 10th or 11th posterior intercostal arteries. The flap was elevated together with the deep fascia at the base.
Methods: Sixteen flaps were used for the repair of defects in different regions in 14 patients, five female and nine male, with a mean age of 45 years. Flap sizes vary from 9x21 to 14x27 cm. The defects were located in anterior thoracic wall in patient four, arm in patient three, axillary fossa in patient three, deltopectoral region in patient two and posterior thoracic wall in patient two.
The mean follow-up period was 13 months.
Result: All flaps survived without total or partial loss. Seroma or contour deformity in the donor area did not develop. A visible scar developed in the donor area in a patient. Flap thinning was performed on two flaps. In all patients, shoulder joint function returned to normal in the last months postoperatively.
Conclusions: If the muscle-sparing latissimus dorsi flap is prepared to include the skin paddle 10th or 11th posterior intercostal arteries and together with the deep fasciae (dorsal thoracic fascia and scarpa’s fascia), it can be safely elevated large sizes.

Anahtar Kelimeler

Muscle-sparing latissimus dorsi flap, posterior intecostal artery, dorsal thoracic fascia, scarpa’s fascia

Kas -Koruyucu Latissimus Dorsi Flebinin Canlılığının Artırılması

Öz

Amaç: Bu çalışmanın amacı kas-koruyucu latissimus dorsi flebinin canlılığını arttırmaktır.
Bu çalışmada, kas-koruyucu latissimus dorsi kas-deri flebi, flebin deri adası torakodorsal arterin distal perforatörleri ve 10. veya 11. posterior interkostal arterlerin perforatörleri üzerinde olacak şekilde tasarlandı. Flep tabandaki derin fasya ile birlikte kaldırıldı.
Yöntem: Beşi kadın, dokuzu erkek, yaş ortalaması 45 olan 14 hastada farklı bölgelerdeki defektlerin onarımı için 16 flep kullanıldı. Flep boyutları 9x21 ila 14x27 cm arasında değişmektedir. Defektler dört hastada toraks ön duvarında, üç hastada kolda, üç hastada aksiller fossada, iki hastada deltopektoral bölgede ve iki hastada toraks arka duvarında yerleşmişti. Ortalama takip süresi 13 aydı.
Bulgular: Tüm flepler tam veya kısmi kayıp olmadan yaşadı. Donör alanda seroma veya kontur deformitesi gelişmedi. Bir hastada donör alanda gözle görülür bir skar oluştu. İki flep üzerinde flep inceltme işlemi uygulandı. Tüm hastalarda ameliyat sonrası son aylarda omuz eklem fonksiyonları normale döndü.
Sonuç: Kas-koruyucu latissimus dorsi kas-deri flebi, deri adası 10. veya 11. posterior interkostal arterleri ve derin fasyaları (dorsal torasik fasya ve skarpa fasyası) içerecek şekilde hazırlanırsa, büyük boyutlarda güvenli bir şekilde kaldırılabilir.

Anahtar Kelimeler

Kas-koruyucu latissimus dorsi flep, posterior intercostal arter, dorsal torasik fasya, scarpa fasyası

Kaynakça

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