Autologous diaphragm reconstruction with the pedicled latissimus dorsi flap.
The latissimus dorsi (LD) muscle has been previously described to repair diaphragmatic defects, but as a "reverse" flap, relying on secondary blood supply from the perforating lumbar vessels rather than primary inflow from the dominant thoracodorsal artery. We report resection of a retroperitoneal synovial sarcoma, with reconstruction of the hemidiaphragm using the LD rotated on its primary neurovascular bundle. By using the dominant pedicle, the vascularity of the flap is improved, minimizing the chance of flap tip loss. Maintaining an intact nerve supply prevents atrophy. As the distal origin of the LD is broad and flat, it is ideally suited for diaphragm repair. A latissimus-sparing thoracotomy incision is required to enable this method of diaphragm reconstruction.
McConkey
M O
MO
School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Temple
C L F
CL
McFadden
S
S
Temple
W J
WJ
D000009:Abdominal Muscles / Q000601:surgery*; D000293:Adolescent; D003964:Diaphragm / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation; D013908:Thoracotomy