Pedicled latissimus dorsi myocutaneous flap for …the length of the latissimus dorsi muscle. After...
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Case Report Page 1 of 2 Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY) For citation purposes: Fang Z, He J, Jin S, Zhang Y, He Y. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction. Annals of Oral & Maxillofacial Surgery 2013 Oct 13;1(3):29. Compeng interests: none declared. Conflict of interests: none declared. All authors contributed to the concepon, design, and preparaon of the manuscript, as well as read and approved the final manuscript. All authors abide by the Associaon for Medical Ethics (AME) ethical rules of disclosure. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction Z Fang 1 , J He 1 , S Jin 1 , Y Zhang 2 , Y He 1 * a variety of local, regional or dis- tant flaps, depending on the specific needs of the patient. For large com- plex defects, the latissimus dorsi myocutaneous flap and pectoralis major myocutaneous flap are com- monly used for reconstruction 1 . We describe a pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction. Case report A 23-year-old woman had a recur- rence of malignant schwannoma in her right neck. After wide resection of the tumour and partial resection of trapezius muscle (Figure 1), a flap was designed according to the size and shape of the defect (Figure 2). Harvesting of the flap was per- formed by making an incision along the length of the latissimus dorsi muscle. After dissection down to muscle, the flaps were elevated anteriorly and posteriorly, expos- ing the entire muscle. The muscle was then divided from its attach- ments and elevated to the level of its thoracodorsal pedicle. The sub- cutaneous tunnel was made from the insertion of the muscle to the neck defect anterior to the axilla and the muscle passed through (Figure 3). The donor-site defect is closed primarily. Closed suction drains are employed at the donor and recipient sites, but not within the tunnel created to pass the flap pedicle (Figure 4). After surgery, the arm is kept flexed across the chest for seven days. Discussion Pedicled flaps, compared with the free flaps, are superior in the head and neck region for the tissue con- sistency they offer 2 . It had proved to be safe and reliable for those patients who underwent radiotherapy. The bulky nature of the pedicled flaps can fulfil the volume requirement of Abstract Introduction In the last decade, pectoralis major myocutaneous flap has become the most frequently used flap to recon- struct the large complex defects in head and neck. Recently, a new method called pedicled latissimus dorsi myocutaneous flap has become a new option. In this study, the advan- tage of pedicled latissimus dorsi myocutaneous flap is summarised. Case report In this study, we report a case of a 23-year-old woman with a recur- rence of malignant schwannoma in her right neck, used pedicled flap to reconstruct the large defect, and proved that the pedicled latissimus dorsi myocutaneous flap is a good choice. Conclusion We have found that this pedicled flap is safe and reliable for large neck defect reconstruction with good contour both in donor and recipient sites. Introduction Defects following ablative surgery in the head and neck region require sophisticated reconstruction using *Corresponding author Email: [email protected] 1 Department of Oral Maxillofacial-Head Neck Oncology, Faculty of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China 2 Department of Plastic Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China Oncology & Reconstruction Figure 1: Large defect of the right neck. Figure 2: Design of the pedicled latissimus dorsi myocutaneous flap. Figure 3: The subcutaneous tunnel.
Transcript of Pedicled latissimus dorsi myocutaneous flap for …the length of the latissimus dorsi muscle. After...
Case Report
Page 1 of 2
Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY)
For citation purposes: Fang Z, He J, Jin S, Zhang Y, He Y. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction. Annals of Oral & Maxillofacial Surgery 2013 Oct 13;1(3):29. Co
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Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction
Z Fang1, J He1, S Jin1, Y Zhang2, Y He1*
a variety of local, regional or dis-tant flaps, depending on the specific needs of the patient. For large com-plex defects, the latissimus dorsi myocutaneous flap and pectoralis major myocutaneous flap are com-monly used for reconstruction1. We describe a pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction.
Case reportA 23-year-old woman had a recur-rence of malignant schwannoma in her right neck. After wide resection of the tumour and partial resection of trapezius muscle (Figure 1), a flap was designed according to the size and shape of the defect (Figure 2). Harvesting of the flap was per-formed by making an incision along the length of the latissimus dorsi muscle. After dissection down to muscle, the flaps were elevated anteriorly and posteriorly, expos-ing the entire muscle. The muscle was then divided from its attach-ments and elevated to the level of its thoracodorsal pedicle. The sub-cutaneous tunnel was made from
the insertion of the muscle to the neck defect anterior to the axilla and the muscle passed through (Figure 3). The donor-site defect is closed primarily. Closed suction drains are employed at the donor and recipient sites, but not within the tunnel created to pass the flap pedicle (Figure 4). After surgery, the arm is kept flexed across the chest for seven days.
DiscussionPedicled flaps, compared with the free flaps, are superior in the head and neck region for the tissue con-sistency they offer2. It had proved to be safe and reliable for those patients who underwent radiotherapy. The bulky nature of the pedicled flaps can fulfil the volume requirement of
AbstractIntroductionIn the last decade, pectoralis major myocutaneous flap has become the most frequently used flap to recon-struct the large complex defects in head and neck. Recently, a new method called pedicled latissimus dorsi myocutaneous flap has become a new option. In this study, the advan-tage of pedicled latissimus dorsi myocutaneous flap is summarised.Case reportIn this study, we report a case of a 23-year-old woman with a recur-rence of malignant schwannoma in her right neck, used pedicled flap to reconstruct the large defect, and proved that the pedicled latissimus dorsi myocutaneous flap is a good choice. ConclusionWe have found that this pedicled flap is safe and reliable for large neck defect reconstruction with good contour both in donor and recipient sites.
IntroductionDefects following ablative surgery in the head and neck region require sophisticated reconstruction using
*Corresponding authorEmail: [email protected] Department of Oral Maxillofacial-Head Neck
Oncology, Faculty of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
2 Department of Plastic Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
Onco
logy
& R
econ
stru
ctio
n
Figure 1: Large defect of the right neck.
Figure 2: Design of the pedicled latissimus dorsi myocutaneous flap.
Figure 3: The subcutaneous tunnel.
Case Report
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Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY)
Com
petin
g in
tere
sts:
non
e de
clar
ed. C
onfli
ct o
f int
eres
ts: n
one
decl
ared
.Al
l aut
hors
con
trib
uted
to th
e co
ncep
tion,
des
ign,
and
pre
para
tion
of th
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anus
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wel
l as r
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and
appr
oved
the
final
man
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All a
utho
rs a
bide
by
the
Asso
ciati
on fo
r Med
ical
Eth
ics (
AME)
eth
ical
rule
s of d
isclo
sure
.
For citation purposes: Fang Z, He J, Jin S, Zhang Y, He Y. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction. Annals of Oral & Maxillofacial Surgery 2013 Oct 13;1(3):29.
large defects after radical resection and can cover major vascular struc-tures such as carotid artery3. The most used pedicled flap is pectoralis major myocutaneous flap. Compared with pectoralis major myocutane-ous flap, pedicled latissimus dorsi myocutaneous flap has some advan-tages including a wider arc of rota-tion with a larger flap dimension, a
Figure 4: The postoperative donor and recipient sites have the closed suction drains.
more acceptable donor site contour for females, a skin island with less hair follicles in males, and a pro-tected localisation in patients treated with radiotherapy.
ConclusionWe have found that this pedicled flap is safe and reliable for large neck defect reconstruction with good con-tour both in donor and recipient sites.
ConsentWritten informed consent was obtained from the patient for publi-cation of this case report and accom-panying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
AcknowledgementThis study was supported by grants of the National Natural Science Foundation of China (NSFC: 30973341, 81271112), and Shu Guang project (10SG19) supported
by Shanghai Municipal Education Commission and Shanghai Educa-tion Development Foundation, the Development Foundation supported by Shanghai Municipal Human Resources and Social Security Bureau (201312), SMC Rising Star Scholar supported by Shanghai Jiao Tong University(A).
References1. Yuen AP, Ng RW. Surgical techniques and results of lateral thoracic cutane-ous, myocutaneous, and conjoint flaps for head and neck reconstruction. Laryngo-scope. 2007 Feb;117(2):288–94.2. Kim EK, Evangelista M, Evans GR. Use of free tissue transfers in head and neck reconstruction. J Craniofac Surg. 2008 Nov;19(6):1577–82.3. Liu R, Gullane P, Brown D, Irish J. Pec-toralis major myocutaneous pedicled flap in head and neck reconstruction: retro-spective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol. 2001 Feb;30(1):34–40.
