[Application of bridged free latissimus dorsi musculo-cutaneous flap on the soft tissue defects in lower extremities].

OBJECTIVE: To evaluate the effect of bridged free latissimus dorsi musculo-cutaneous flap on repairing of soft tissue defect in the lower extremity.

METHODS: Seven patients with extensive soft tissue defects in the lower extremities were enrolled in the clinical investigation. The defects were all repaired with bridged free latissimus dorsi musculo-cutaneous flaps. The condition of the blood vessels in the flaps and the healthy extremities was examined with ultrasound Doppler before the operation to assure the blood circulation of grafted flap. After debridement, the flap was designed in accordance with the size and the depth of the wound. Then the transplantation of the flaps were done. The operative indication and points for attention were summarized thereafter.

RESULTS: All the 7 flaps survived. All patients recovered well with satisfactory function and external appearance, except flap reduction was done in 2 patients due to undue thickness of the flaps. Indications for operation: (1) Patients with anterior or posterior tibial artery injury in the injured lower extremity in which arterial transplantation was not possible to allow the free transplantation of a skin flap. (2) The injury was extensive and deep, with the injurious condition of the blood vessels indeterminable and no healthy artery could be found for anastomosis with a donor artery. (3) No vascular injury could be identified in the contralateral healthy extremity. Points for attention included that the blood supply of the flap to be transferred should be adequate, and the survival of the flap after division of the pedicle should be assured. The length of the flap to be transferred should be longer by 10% than the distance between the site of transplantation in the lower extremities and the donor area; and the donor area should be larger by 20% than the recipient area. The skin area of the flap to be transferred should be broad enough avoid tension so that there would be no pressure on the blood vessels. Pay attention to the blood supply of the flap after operation, and the recipient limb should be properly immobilized.

CONCLUSION: The repair of extensive soft tissue defect in the lower extremity with bridged free latissimus dorsi musculo-cutaneous flap could be satisfactory. Proper wound management, broad flap, stable immobilization were the pivotal points for the success of the operation.