A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects.

BACKGROUND: The main drawback of the latissimus dorsi myocutaneous flap for large defect repairs is the relatively small skin paddle size that can be raised to allow primary closure of the donor site. In this article, the authors describe a novel design of the flap using multiple separate skin paddles, with each paddle nourished by independent perforators, to repair very large defects while maintaining primary donor-site closure.

METHODS: After the size of the defect was calculated, its total area was split into two or three skin paddles and marked on the back skin so that the largest width of each paddle did not exceed 8 cm. A multilobed skin paddle was designed with a total area that was much larger than traditional latissimus dorsi flaps. After harvesting the flap, several smaller skin paddles were transferred and rejoined at the recipient site.

RESULTS: From June of 2009 to March of 2012, this method was used to restore posttraumatic and postoncologic defects of the head in seven cases and lower limb defects in two cases. Seven flaps were raised as bilobed flaps, and two flaps were raised as trilobed flaps. The donor site was closed primarily in all cases. One case was complicated by partial necrosis of one paddle and required further local flap coverage. Donor-site breakdown was not observed in any of the cases.

CONCLUSIONS: The multilobed myocutaneous latissimus dorsi flap enables a customized reconstruction of large defects for all types of patients and direct closure of the donor site.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.