Clinical anatomy of the free latissimus dorsi myocutaneous flap and its application in the restoration of giant defects of the head and neck

doi:10.19439/j.sjos.2024.03.010

Abstract

Abstract: PURPOSE: To investigate the feasibility and effect of free latissimus dorsi myocutaneous flap in the reconstruction of giant head and neck defects. METHODS: Free latissimus dorsi myocutaneous flap on the cadaver was simulated dissected, and measured by Image-Pro Plus 6.0 to assess the feasibility of repairing giant head and neck defects. Between May 2011 and September 2022, seven patients with giant head and neck defects of different causes repaired with the latissimus dorsi myocutaneous flap were retrospectively analyzed. RESULTS: The diameter of the initiating thoracodorsal artery was (4.03±0.56) mm, and the mean lengths of the arteriolar and venous pedicles of the latissimus dorsi myocutaneous flaps obtained from human specimens were (85.5±10.5) mm and (104±4.2) mm, respectively. Among 7 patients, 5 cases had scalp defects, the remaining 2 cases had neck defects. There were no substantial postoperative problems in the donor site, and all seven latissimus dorsi myocutaneous flaps were successfully transplanted. CONCLUSIONS: For the treatment of considerable head and neck deformities, the latissimus dorsi myocutaneous flap is an optimal muscle flap due to its abundance of tissue, enough length of vascular pedicles, and sufficient venous drainage.

Key words: Free latissimus dorsi myocutaneous flap, Anatomy of latissimus dorsi myocutaneous, Giant head and neck defect, Restoration, Software Image-Pro Plus 6.0

CLC Number:

R782.2

QIAN Ye-mei, WANG Wei-hong, ZHU Jin, HE Yong-jing, XU Biao, ZOU Zhi-rong, SHI Yan-an, LUO Lei, LI Jing-yi. Clinical anatomy of the free latissimus dorsi myocutaneous flap and its application in the restoration of giant defects of the head and neck[J]. Shanghai Journal of Stomatology, 2024, 33(3): 269-272.

References

[1] 吴海涛, 程磊, 陶磊, 等. 游离皮瓣修复头颈部肿瘤术后组织缺损[J]. 中国眼耳鼻喉科杂志, 2019, 19(5): 325-331.
[2] 王元, 房居高, 黄志刚, 等. 游离胫后动脉穿支皮瓣与游离前臂桡侧皮瓣在修复头颈部缺损中的临床比较研究[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(11): 1158-1163.
[3] 李萌, 杜洪明, 武和明, 等. 改良前臂皮瓣在头颈部缺损修复中的应用[J]. 实用口腔医学杂志, 2020, 36(6): 915-918.
[4] 杨晓敏, 何永静, 张娟, 等. 背阔肌肌皮瓣和股前外侧皮瓣游离移植修复头皮鳞状细胞癌术后创面的效果观察[J].中华整形外科杂志, 2021, 37(4): 418-422.
[5] 唐友盛, 邱蔚六, 刘世勋, 等. 颌面大型洞穿性缺损立即吻合血管的组织瓣整复[J]. 上海口腔医学, 1993, 2(3): 125-127.
[6] 王卫红, 邹智荣, 黎明, 等. 颏下岛状皮瓣在修复舌癌术后缺损中的临床应用[J].口腔颌面外科杂志, 2009, 19(5): 345-348.
[7] 赵茹, 乔群, 柳成, 等. 背阔肌分区的解剖及临床应用[J]. 中国修复重建外科杂志, 2003, 17(1): 38-40.
[8] 夏有辰, 李比, 陈小迅, 等. 背阔肌肌皮瓣的血管解剖及其临床应用[J]. 解剖学报, 2020, 51(1): 93-97.
[9] O'Connell JE, Bajwa MS, Schache AG, et al. Head and neck reconstruction with free flaps based on the thoracodorsal system[J]. Oral Oncol, 2017, 75: 46-53.
[10] 任振虎, 范腾飞, 游元和, 等. 胸背动脉穿支皮瓣在头颈部缺损修复中的临床应用[J].中华耳鼻咽喉头颈外科杂志, 2021, 56(9): 914-918.
[11] Vucak MC, Masic T, Hassouba M, et al.Reconstructive option of extensive head and neck defects in cancer surgery[J]. Med Arch, 2013, 67(4): 275-277.
[12] 戴捷, 周晓, 喻建军, 等. 头颈部巨大皮肤恶性肿瘤切除术后缺损修复[J].中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 125-128.
[13] 翟沁凯, 王绪凯, 卢利, 等. 游离皮瓣移植修复口腔颌面部缺损的临床效果观察[J].口腔医学, 2011, 31(3): 162-165.
[14] Chepeha DB, Khariwala SS, Chanowski EJ, et al.Thoracodorsal artery scapular tip autogenous transplant: vascularized bone with a long pedicle and flexible soft tissue[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(10): 958-964.
[15] Bach CA,Wagner I, Lachiver X, et al.The free thoracodorsal artery perforator flap in head and neck reconstruction[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2012, 129(3): 167-171.
[16] 蔡雨宸, 张国佑, 廉洁, 等. 游离背阔肌扩张皮瓣在膝前大面积组织缺损修复中的应用[J]. 组织工程与重建外科, 2021, 17(4): 314-316.
[17] Pau M, Wallner J, Feichtinger M, et al.Free thoracodorsal, perforator-scapular flap based on the angular artery (TDAP-Scap-aa): clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects[J]. J Craniomaxillofac Surg, 2019, 47(10): 1617-1625.
[18] 范腾飞, 任振虎, 杨雯君, 等. 胸背动脉穿支皮瓣修复口腔癌复发后软组织缺损的疗效分析[J].口腔医学研究, 2021, 37(11): 1036-1038.
[19] Dong L, Dong Y, Liu C, et al.Latissimus dorsi-myocutaneous flap in the repair of titanium mesh exposure and scalp defect after cranioplasty[J]. J Craniofac Surg, 2020, 31(2): 351-354.
[20] Xiao Y, Xiao H, Wan H, et al.Pre-expanded latissimus dorsi myocutaneous flap for total scalp defect reconstruction[J]. J Craniofac Surg, 2020, 31(2): e151-e153.
[21] Hu L, Xi Y, Wang Y, et al.Reconstruction with soft tissue free flaps for large defects after the resection of giant facial neurofibroma[J]. Int J Oral Max Surg, 2017, 46(4): 440-446.