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

• 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
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2011.08.034

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.