Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: An anatomical study of flap pedicle modification

Issue title: Selected articles from the 3rd Joint Meeting of The European Society for Clinical Hemorheology and Microcirculation (ESCHM) , The International Society for Clinical Hemorheology (ISCH) and The International Society of Biorheology (ISB), Regensburg, Germany, 28 – 30 September 2023

Guest editors: L. Prantl, A. Krueger-Genge and F. Jung

Article type: Research Article

Authors: Ernert, Carsten^{a; *} | Kielstein, Heike^b | Azatyan, Argine^c | Prantl, Lukas^d | Kehrer, Andreas^{d; e}

Affiliations: [a] Department of Plastic, Hand and Microsurgery, Ev. Waldkrankenhaus Spandau, Berlin, Germany | [b] Institute of Anatomy, Martin Luther University Halle Wittenberg, Halle, Germany | [c] Department of Plastic, Reconstructive and Breast Surgery, Görlitz Hospital, Görlitz, Germany | [d] Department of Plastic and Reconstructive Surgery, University Medical Center, Regensburg, Germany | [e] Division of Hand and Plastic Surgery, Ingolstadt Hospital, Ingolstadt, Germany

Correspondence: [*] Corresponding author: Carsten Ernert, Department of Plastic, Hand and Microsurgery, Ev. Waldkrankenhaus Spandau, Berlin, Germany. Tel.: +491772823188; E-mail: [email protected].

Abstract: BACKGROUND:Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE:This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS:Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS:Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS:By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap.

Keywords: Latissimus dorsi myocutaneous flap, deep sternal wound infection, circumflex scapular artery, microsurgery, single flap reconstruction, sternal reconstruction, sternal defect

DOI: 10.3233/CH-238115

Journal: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 225-236, 2024