Flow-Through, Functioning, Free Musculocutaneous Flap Transfer for Restoration of a Mangled Extremity

ABSTRACT

Reconstructing a mangled extremity requires careful, complete examination of the functional and structural status of the injured part. Although the vascular status of the injured extremity is a priority, simultaneous reconstruction of skeletal, vascular, and neuromuscular structures should be considered in a combined approach. The purpose of this study was to describe a one-stage reconstruction of both soft-tissue coverage and revascularization for a lower extremity, along with functional restoration of an anterior lower leg. For this purpose, the functioning transfer of a free latissimus dorsi musculocutaneous flap as a flow-through type was performed. The results demonstrate that the technique is extremely useful in limb-salvage procedures from both functional and structural viewpoints.

KEYWORDS

Lower-extremity reconstruction - flow-through latissimus dorsi flap - functional transfer

REFERENCES

• 1 Byrd H S, Spicer T E, Cierney G. Management of open tibial fractures.  Plast Reconstr Surg. 1985;  76 719-730
• 2 Godina M. Early microsurgical reconstruction of complex trauma of the extremities.  Plast Reconstr Surg. 1986;  78 285-292
• 3 Dao Q S, Zhang Y F, Yang Q M, Guo B F. Free gracilis transfer in the treatment of gluteus medius paralysis after poliomyelitis.  J Reconstr Microsurg. 1985;  1 241-244
• 4 Kobayashi S, Sekiguchi J, Sakai Y, Ohmori K. Functioning free muscle transplantation to the lower leg.  J Reconstr Microsurg. 1995;  11 319-325
• 5 Doi K, Sakai K, Ihara K et al.. Reinnervated free muscle transplantation for extremity reconstruction.  Plast Reconstr Surg. 1993;  92 872-883
• 6 Ihara K, Shigetomi M, Kawai S et al.. Functioning muscle transplantation after wide excision of sarcomas in the extremity.  Clin Orthop. 1999;  358 140-148
• 7 Ihara K, Kishimoto T, Kawai S, Doi K. Reconstruction of hip abduction using free muscle transplantation: a case report and description of the technique.  Ann Plast Surg. 2000;  45 177-180
• 8 Willcox T M, Smith A A, Beauchamp C, Meland N B. Functional free latissimus dorsi muscle flap to the proximal lower extremity.  Clin Orthop. 2003;  410 285-288
• 9 Soutar D S, Scheker L R, Tanner N S, McGregor I A. The radial forearm flap: a versatile method for intra-oral reconstruction.  Br J Plast Surg. 1983;  36 1-8
• 10 Lamberty B G, Cormack G C. The antecubital fascio-cutaneous flap.  Br J Plast Surg. 1983;  36 428-433
• 11 Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese flap.  Br J Plast Surg. 1984;  37 139-148
• 12 Costa H, Guimaraes I, Gardoso A et al.. One stage coverage and revascularization of traumatized limbs by a flow-through radial mid-forearm free flap.  Br J Plast Surg. 1991;  44 533-537
• 13 Lovie M J, Duncan G, Glasson D W. The ulnar artery forearm free flap.  Br J Plast Surg. 1984;  37 486-492
• 14 Song R, Song Y, Yu Y et al.. The upper arm free flap.  Clin Plast Surg. 1982;  9 27-35
• 15 Masquelet A C, Romana M C. The medialis pedis flap: a new fasciocutaneous flap.  Plast Reconstr Surg. 1990;  85 765-772
• 16 Naotaka I, Takaya H, Sadao T. The use of a free medialis pedis flap for resurfacing skin defects of the hand and digits: results in five cases.  Plast Reconstr Surg. 1995;  95 100-107
• 17 Koshima I, Moriguchi T, Soeda S et al.. Free thin paraumbilical perforator-based flaps.  Ann Plast Surg. 1992;  29 12-17
• 18 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
• 19 Brandt K, Khouri R K, Upton J. Free flaps as flow-through vascular conduits for simultaneous coverage and revascularization of the hand and digit.  Plast Reconstr Surg. 1996;  98 321-327
• 20 Koshima I, Inagawa K, Sahara K et al.. Flow through vascular toe-joint transfer for reconstruction of segmental loss of an amputated finger.  J Reconstr Microsurg. 1998;  14 453-457
• 21 Shibata M, Ogishyo N. Free flaps based on the anterior interosseous artery.  Plast Reconstr Surg. 1996;  97 746-755
• 22 Koshima I, Kawada S, Etoh H et al.. Flow-through anterior thigh flaps for one stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.  Plast Reconstr Surg. 1995;  95 252-260
• 23 Koshima I, Saisho H, Kawada S et al.. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs.  Plast Reconstr Surg. 1999;  103 1483-1490
• 24 Tseng W S, Chen H C, Hung J et al.. Flow-through type free flap for revascularization and simultaneous coverage of a nearly complete amputation of the foot: case report and literature review.  J Trauma. 2000;  48 773-776
• 25 Nişanci M, Işik S, Duman H. Flow-through use of the osteomusculocutaneous free fibular flap.  Ann Plast Surg. 2002;  48 435-438
• 26 Chun J K, Marin M L. Radial artery flow-through flap for distal lower extremity arterial bypass for limb salvage.  Plast Reconstr Surg. 2003;  111 361-365
• 27 Tamai S, Komatsu S, Sakamoto H et al.. Free muscle transplants in dogs, with microsurgical neurovascular anastomoses.  Plast Reconstr Surg. 1970;  46 219-225
• 28 Manktelow R T, Zuker R M. The principles of functioning muscle transplantation: applications to the arm.  Ann Plast Surg. 1989;  22 275-282
• 29 Manktelow R T. Functioning microsurgical muscle transfer.  Hand Clin. 1988;  4 289-296
• 30 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation with neurovascular anastomoses for the treatment of facial paralysis: a preliminary report.  Plast Reconstr Surg. 1976;  57 133-143
• 31 Harii K. Microneurovascular free muscle transplantation for reanimation of facial paralysis.  Clin Plast Surg. 1979;  6 361-375
• 32 Koshima I, Higaki H, Soeda S. Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm.  Plast Reconstr Surg. 1991;  88 338-341
• 33 Kim D H, Glazer P A. Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report.  Spine. 2000;  25 622-625
• 34 Tobin G R, Moberg A W, DuBou R H et al.. The split latissimus dorsi myocutaneous flap.  Ann Plast Surg. 1981;  7 272-280