title: Free latissimus dorsi flap with long venous grafts for closure of a soft tissue defect of the spine in a patient with Noonan's syndrome: a case report.
abstract: A 23-year-old male patient was operated for a soft tissue defect of the spine using a free musculocutaneous latissimus dorsi flap with two 21-cm long venous grafts connecting the flap to its vascular supply at the thoracodorsal vessels. This young patient suffered from Noonan's Syndrome that is a complex hereditary malformation syndrome with clinical features often leading to spinal deformities and gibbus development. The defect originated from a former internal vertebral fixation that was necessary for erective correction of such a spinal deformity. After perforation of the introduced material and debridement the defect was 4 x 8 cm in size, which was successfully closed by the free latissimus dorsi transfer. However, two venous grafts were necessary because the extension of the pedicled muscle was not sufficient to reach the defect. This is the first case in literature where a free flap was used with two venous grafts to close a soft tissue defect of the spine in the special case of a vertebral deformity based on a Noonan's Syndrome.
authors.affiliation: Department of Plastic Surgery, Vogtareuth Medical Treatment Center, Vogtareuth, Germany. nsinis@bgu-tuebingen.de
authors.forename: Nektarios
authors.initials: N
authors.lastname: Sinis
authors.forename: Tatjana Ismini
authors.initials: TI
authors.lastname: Lanaras
authors.forename: Armin
authors.initials: A
authors.lastname: Kraus
authors.forename: Frank
authors.initials: F
authors.lastname: Werdin
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
authors.forename: Alberto
authors.initials: A
authors.lastname: Peek
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D007738:Kyphosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods; D009634:Noonan Syndrome / Q000150:complications*; D010369:Pectoralis Muscles / Q000098:blood supply / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult