Reconstruction of extensive lower limb defects with thoracodorsal axis chimeric flaps.

BACKGROUND: Extensive defects of the lower extremities are usually reconstructed with microvascular free flaps because of inadequate local tissues and wound complexity. Many attempts have been made to reconstruct such defects using the chimeric flap concept, enabling flaps with larger surface areas to be used while maintaining economical tissue use. The latissimus dorsi chimeric flap is one of the most useful tools for resurfacing extensive limb defects.

METHODS: Twelve patients with extensive lower leg defects underwent reconstruction with latissimus dorsi chimeric flaps between January of 2008 and March of 2012. A skin flap based on the cutaneous perforators, a latissimus dorsi muscle flap based on the muscular branches, and a serratus anterior muscle flap based on the branch from the thoracodorsal artery were harvested accordingly; the flap design depended on the dimensions and characteristics of the defect.

RESULTS: A total of 12 chimeric flaps were harvested and used, with the average surface area, including skin and muscle components, being 614 cm. The mean surface area of the skin flaps used was 355.6 cm. The mean area of the latissimus dorsi muscle flap was approximately 228 cm, and the surface areas of the three serratus anterior flaps used were 56 cm, 70 cm, and 180 cm. Flaps survived in all cases. Primary closure was used for all of the donor sites except one, and there was minimal donor-site morbidity.

CONCLUSION: The authors' results show that the latissimus dorsi chimeric free flap is a useful and versatile reconstructive option for extensive defects of the lower extremities.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.