The conjoined latissimus dorsi and parascapular free flap for reconstruction of extensive soft tissue defects

Oper Orthop Traumatol. 2023 May 8. doi: 10.1007/s00064-023-00806-w. Online ahead of print.ABSTRACTOBJECTIVE: Durable and resilient soft tissue reconstruction of vast defects of the extremities or the torso.INDICATIONS: Reconstruction of disproportionately large defects, particularly in cases of simultaneous bone and joint reconstruction.CONTRAINDICATIONS: History of surgery or irradiation of upper back and axilla, impossibility of surgery under lateral positioning; relative contraindications in wheelchair users, hemiplegics, or amputees.SURGICAL TECHNIQUE: General anesthesia and lateral positioning. First, the parascapular flap is harvested, with the initial skin incision made medially in order to identify the medial triangular space and the circumflex scapular artery. Flap raising then proceeds from caudal to cranial. Second, the latissimus dorsi is harvested, with the lateral border being dissected free first, before the thoracodorsal vessels are visualized on its undersurface. Flap raising then proceeds from caudal to cranial. Third, the parascapular flap is advanced through the medial triangular space. If the circumflex scapular and thoracodorsal vessels originate separately from the subscapular axis, an in-flap anastomosis is warranted. Subsequent microvascular anastomoses should be performed outside the zone of injury, typically in an end-to-end fashion of the vein and end-to-side fashion of the artery.POSTOPERATIVE MANAGEMENT: Postoperative anticoagulation with low-mol...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Source Type: research