Reconstruction of the Shoulder Region Using a Pedicled Latissimus Dorsi Flap Following Soft Tissue Sarcoma Resection

Introduction: The latissimus dorsi flap is probably the most commonly used and reliable flap for reconstruction. The advantages of this flap include a constant vascular anatomy, long and high-caliber vessels, a high density of myocutaneous perforators to the overlying skin, minimal donor site morbidity and technical ease of flap raising. In particular, a pedicled latissimus dorsi flap can be used to repair defects around the shoulder region.

The present report details our experience using pedicled latissimus dorsi flaps for reconstruction after resection of soft tissue sarcomas of the shoulder.

Methodology and Material: This study involved a retrospective review of the medical and physical examination records of six patients with soft tissue sarcomas of the shoulder region who underwent wide resection and pedicled latissimus dorsi flap reconstruction between 2004 and 2006. Three patients were men and three patients were women, with a mean age of 37 years (range, 19 - 49). Two patients had a dermatofibrosarcoma protuberance, one a synovial sarcoma, one a high-grade round cell sarcoma, one a myxofibrosarcoma, and one had a malignant peripheral nerve sheath tumor. Four patients were referred to our hospital after simple excision with an inadequate margin at other local hospitals. According to the American Joint Committee on Cancer (AJCC) system, there were two stage; A, B, and patients. Three patients underwent postoperative radiation therapy, and one patient received postoperative chemotherapy. The study assessed the flap state, survival, postoperative complications and functional results using the scoring system of the Musculoskeletal Tumor Society for the upper extremity. The mean follow-up period was 27.3 months (range, 14 - 34).

Results: There were no major postsurgery complications, and all flaps survived. There were no recurrence and patient deaths during the study period. The mean flap surface area was 108 cm2 (range, 63 - 189). Only one flap exhibited partial skin necrosis, and this healed with conservative treatment. After wound healing, one patient underwent radiation therapy, resulting in severe color change at the flap site. Morbidity of the donor sites was minimal in all patients, and there were no incidences of seroma formation or wound dehiscence. All patients expressed satisfaction with the cosmetic and functional results. The mean functional score was 29.7 (range, 28-30) (Table 2).

Conclusions: We believe that using a pedicled latissimus dorsi flap is safe and reliable, and that it may become the treatment of choice for repair of extensive defects of the shoulder region after oncological resection. This flap provides wide coverage, and the present study found that all patients were satisfied with the cosmetic and functional results, and no complications occurred.