Use of Intercostal Perforating Veins and Long Arterial Grafts for Latissimus Myocutaneous Free Flap Reconstruction of Radiated Low Back Wounds

The lumbar region is considered a “no-man's land” for flap coverage. Local flaps are relatively thick, have poor skin elasticity, and have tight adhesions to the deeper layers.[1] Myocutaneous flap coverage of the lumbar region can provide bulk using vascularized tissue and avoids skin grafts in a high-shear area. Pedicled latissimus and gluteus muscle-based flaps can cover lumbar wounds but these flaps often “just reach,” leaving them subject to the Second Law of Vasconez: “All of the flap will survive except the part that you need.”[2] This Law is particularly relevant in patients with limited or nonexistent pedicled options, including those with prior operative procedures, prior flap coverage, or a history of radiation. Some authors believe that free tissue transfer is the procedure of choice for lumbosacral wounds that are large, recurrent, and/or infected.[1]

We report on two patients with lumbar wounds in previously radiated fields. Both patients were managed using free myocutaneous latissimus flap coverage with inflow from a long vein graft to the thoracodorsal artery and outflow to intercostal perforating veins.

Note

No funding source contributed to this article.

• References

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