Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 7;102(19):1714-1723.
doi: 10.2106/JBJS.20.00022.

Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction: Five-Year Consecutive Single-Surgeon Series

Harvey Chim  1 , Rachel Cohen-Shohet, Mariel M McLaughlin, Tosan Ehanire
Affiliations

Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction: Five-Year Consecutive Single-Surgeon Series

Harvey Chim et al. J Bone Joint Surg Am. .

Abstract

Background: The free split latissimus dorsi flap for lower-extremity reconstruction has some advantages over the traditional latissimus dorsi flap. The flap is harvested with the patient in the supine position and is associated with minimal morbidity as the function of the remaining latissimus dorsi muscle is preserved through the posterior division of the thoracodorsal nerve.

Methods: A consecutive single-surgeon 5-year series of free split latissimus dorsi muscle flaps for lower-extremity reconstruction (n = 42) was evaluated. Donor site morbidity was evaluated through assessment of the strength of the remaining latissimus dorsi at least 1 month after surgery. Shoulder function was evaluated postoperatively using the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Pain and Disability Index (SPADI).

Results: The mean age of the 42 patients was 40.7 years. The mean length and width of the flaps were 17.9 cm and 8.6 cm. The majority (71%) of the wounds were due to acute trauma. Of the 42 flap procedures performed, 95% (40) were successful. Assessment of remaining latissimus dorsi strength at least 1 month postoperatively, during 3 activities, showed a Medical Research Council (MRC) grade of 5 in all patients. The mean and median scores were 6.4 and 0 according to the DASH, 6.0/6.4 and 0/0 on the SPADI pain/disability scales, and 90.7 and 100 on the ASES.

Conclusions: The free split latissimus dorsi flap is a large reliable muscle flap with negligible donor site morbidity that is particularly advantageous for lower-extremity resurfacing following trauma.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

References

    1. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002 Jun;109(7):2219-26, discussion 2227-30.
    1. Tobin GR, Schusterman M, Peterson GH, Nichols G, Bland KI. The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap. Plast Reconstr Surg. 1981 May;67(5):637-41.
    1. Tobin GR, Moberg AW, DuBou RH, Weiner LJ, Bland KI. The split latissimus dorsi myocutaneous flap. Ann Plast Surg. 1981 Oct;7(4):272-80.
    1. Lin CH, Wei FC. Widely split latissimus dorsi muscle flaps for reconstruction of long soft-tissue defects in lower extremities. Plast Reconstr Surg. 2000 Feb;105(2):706-9.
    1. Terzi A, Luzzi L, Campione A, Gorla A, Calabrò F. The split latissimus dorsi muscle flap to protect a bronchial stump at risk of bronchial insufficiency. Ann Thorac Surg. 2009 Jan;87(1):329-30.