J Reconstr Microsurg 2006; 22(3): 157-166
DOI: 10.1055/s-2006-939961
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction of Crush Injuries of the Foot Dorsum: Is the Latissimus Dorsi Muscle Flap a Reliable Choice?

Guniz Eker Uluçay1 , Serkan Yildirim1 , Eser Aydoğdu1 , Tayfun Aköz1
  • 1Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
Further Information

Publication History

Accepted: December 1, 2005

Publication Date:
06 July 2006 (online)

ABSTRACT

Thirteen patients who underwent 13 latissimus dorsi free flaps for subacute foot dorsum defects were identified over a 4-year period. The average age of the patients was 30.5 years (range: 8 to 52 years). There were eight male, five female patients. The average follow-up was 23 months (range: 2 to 47 months). The soft-tissue defect resulted from motor vehicle accident in all cases. All of the patients presented with soft-tissue loss combined with extensor tendon and/or bone injury. The wounds were treated with serial debridement and free latissimus dorsi or latissimus dorsi-serratus anterior muscle and split-thickness skin graft coverage in all cases. The mean size of the flaps was 19 × 11 cm (range: 15 to 24 cm × 9 to 16 cm). Twelve of 13 flaps survived. Complications included infection (1 case), seroma in the donor region (2 cases), total flap failure (1 case), partial flap necrosis (2 cases), and wound dehiscence (2 cases).

REFERENCES

  • 1 Rainer C, Schwabegger A H, Bauer T et al.. Free flap reconstruction of the foot.  Ann Plast Surg. 1999;  42 595-606
  • 2 Hidalgo D A, Shaw W W. Anatomic basis of plantar flap design.  Plast Reconstr Surg. 1986;  78 627-636
  • 3 Ninkovic M, Scholler T, Benedetto K P et al.. Emergency free flap cover in complex injuries of the lower extremities.  Scand J Plast Reconstr Surg Hand Surg. 1996;  30 37-47
  • 4 Clark N, Sherman R. Soft tissue reconstruction of the foot and ankle.  Orthop Clin North Am. 1993;  24 489-503
  • 5 Yıldırım S, Akan M, Aköz T. Soft tissue reconstruction of the foot with distally based neurocutaneous flaps in diabetic patients.  Ann Plast Surg. 2002;  48 258-264
  • 6 Masquelet A C, Romana M C, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience.  Plast Reconstr Surg. 1992;  89 1115-1121
  • 7 Fraccalvieri M, Verna G, Dolcet M et al.. The distally based superficial sural flap: our experience in reconstruction of the lower leg and foot.  Ann Plast Surg. 2000;  45 132-139
  • 8 Yıldırım S, Akan M, Gideroğlu K, Aköz T. Use of distally based neurofasciocutaneous and musculocutaneous cross-leg flaps in limb salvage.  Ann Plast Surg. 2001;  47 568-574
  • 9 Long C D, Granick M S, Solomon M P. The cross-leg flap revisited.  Ann Plast Surg. 1993;  30 560-563
  • 10 Weinzweig N, Davies B W. Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.  Plast Reconstr Surg. 1998;  102 1999-2005
  • 11 Musharafieh R, Atiyeh B, Macari G, Haidar R. Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases.  J Reconstr Microsurg. 2001;  17 147-150
  • 12 Luo S, Raffoul W, Luo J et al.. Anterolateral thigh flap: a review of 168 cases.  Microsurgery. 1999;  19 232-238
  • 13 Kimura N, Satoh K, Hasumi T et al.. Clinical application of free thin anterolateral thigh flaps in 31 consecutive patients.  Plast Reconstr Surg. 2001;  108 1197-1208
  • 14 Koshima I, Fukuda H, Yamamato H et al.. Free anterolateral thigh flaps for reconstruction of head and neck defects.  Plast Reconstr Surg. 1993;  92 421-430
  • 15 Yıldırım S, Avcı G, Aköz T. Soft tissue reconstruction using a free anterlateral thigh flap: experience with 28 patients.  Ann Plast Surg. 2003;  51 37-44
  • 16 Yıldırım S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction.  J Reconstr Microsurg. 2003;  19 225-233
  • 17 İsmail T I. The free fascial forearm flap.  Microsurgery. 1989;  10 155-160
  • 18 Brent B, Upton J, Acland R D et al.. Experience with the temporal parietal fascial free flap.  Plast Reconstr Surg. 1985;  76 177-188
  • 19 Chowdary R P, Chernofsky M A, Okunski W J. Free temporal parietal flap in burn reconstruction.  Ann Plast Surg. 1990;  25 169-173
  • 20 Salgado C J, Orlando G S, Serletti J M. Clinical applications of the posterior rectus sheath-peritoneal free flap.  Plast Reconstr Surg. 2000;  106 321-326
  • 21 May Jr J W, Halls M J, Simon S R. Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study.  Plast Reconstr Suirg. 1985;  75 627-639
  • 22 Nuzumlali E, Gürbüz C, Kantarcı Ü. Moving car tire injuries of the foot: reconstruction with microvascular free flaps.  J Reconstr Microsurg. 1996;  12 297-302
  • 23 Franceschi N, Yim K K, Lineaweaver W C et al.. Eleven consecutive combined latissimus dorsi and serratus anterior free muscle transplantations.  Ann Plast Surg. 1991;  27 121-125
  • 24 Chen H C, Chuang C C, Chen S, Hsu W M, Wei F C. Selection of recipient vessels for free flaps to the distal leg and foot following trauma.  Microsurgery. 1994;  15 358-363
  • 25 Wolff K D, Stiller D. Ischemia tolerance of free-muscle flaps: an NMR-spectroscopic study in the rat.  Plast Reconstr Surg. 1993;  91 485-491
  • 26 Schwabegger A, Ninkovic M, Brenner E et al.. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention.  Ann Plast Surg. 1997;  38 594-597
  • 27 Rios J L, Pollock T, Adams Jr W P. Progressive tension sutures to prevent seroma formation after latissimus dorsi harvest.  Plast Reconstr Surg. 2003;  112 1779-1783
  • 28 Weinrach J C, Cronin E D, Smith B K, Collins Jr D R, Cohen B E. Preventing seroma in the latissimus dorsi flap donor site with fibrin sealant.  Ann Plast Surg. 2004;  53 12-16
  • 29 Sawada Y, Sone K. Beneficial effects of silicone cream on grafted skin.  Br J Plast Surg. 1992;  45 105-108
  • 30 Haq M A, Haq A. Pressure therapy in treatment of hypertrophic scar, burn contracture and keloid: the Kenyan experience.  East Afr Med J. 1990;  67 785-793
  • 31 Isik S, Celikoz B, Demirogullari M et al.. Repair of high-energy-induced tissue defects of the dorsal foot by free muscle transfer and skin graft.  Ann Plast Surg. 1999;  43 21-29
  • 32 Marek C A, Pu L L. Refinements of free tissue transfer for optimal outcome in lower extremity reconstruction.  Ann Plast Surg. 2004;  52 270-275
  • 33 Godina M. Early microsurgical reconstruction of complex trauma of the extremities.  Plast Reconstr Surg. 1986;  78 285-292

Guniz Eker UluçayM.D. 

Emanet Sok. Sema Apt. No: 9 D: 10 Bostanci

Istanbul, Turkey

    >