Use of latissimus dorsi flap pedicle as a T-junction to facilitate simultaneous free fibular flap inset in lower extremity salvage

Summary Marjolin’s ulcer is a very aggressive form of squamous cell carcinoma arising from chronic wounds or unstable scars. A resection margin of at least 2 cm with clear deep margin is required on removal. A 79-year-old male presented with chronic osteomyelitis of the left anterior tibial region w...

Full description

Saved in:
Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2012-04, Vol.65 (4), p.517-520
Main Authors: Hwang, Kyu Tae, Youn, Seungki, Kim, Jeong Tae, Lee, Seung Hoon, Ng, Siew-Weng, Kim, Youn Hwan
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Bone Neoplasms - surgery
Branch to serratus anterior muscle
Bridging flap
Carcinoma, Squamous Cell - surgery
Dermatology
Fibular free flap
Humans
Latissimus dorsi free flap
Leg
Male
Marjolin’s ulcer
Medical sciences
Osteomyelitis - complications
Plastic Surgery
Salvage Therapy - methods
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Flaps
T-anastomosis
Tibia
Tibial reconstruction
Tumors of the skin and soft tissue. Premalignant lesions
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Marjolin’s ulcer is a very aggressive form of squamous cell carcinoma arising from chronic wounds or unstable scars. A resection margin of at least 2 cm with clear deep margin is required on removal. A 79-year-old male presented with chronic osteomyelitis of the left anterior tibial region with chronic ulceration. Biopsy revealed squamous cell carcinoma. The tumour, measuring 8 cm, was resected with surrounding unstable scar tissue including en bloc resection of the involved tibial bone, leaving the posterior cortex. Reconstruction was done with a fibular free flap from the contralateral side, but the pedicle length was too short to reach the anterior tibial vessels. To bridge the vascular gap, and to cover the soft-tissue defect, a latissimus dorsi free flap was harvested using the muscle-sparing method. The thoracodorsal vessels were used as an interpositional graft to anastomose the peroneal vessels of the fibular flap. The patient was ambulatory by 4 months, and complete bone union was seen after 6 months. During the 18-month follow-up period, there was no evidence of recurrence.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2011.08.034