title: Combined latissimus dorsi and serratus anterior flaps for pelvic reconstruction.
abstract: In recurrent pressure sores, adjacent tissue has already been consumed by multiple surgeries. Additional problems are several co-morbidities of patients. Especially, severe atherosclerosis would be a contraindication for using free flaps. However, microsurgical techniques allow circumventing these limitations and preparing even severely atherosclerotic vessels. We performed a total of eight sacral pressure sore coverage in our standardized fashion, using the free combined latissimus dorsi and serratus anterior free flaps. All patients had severe atherosclerosis and needed large soft tissue coverage of the sacral defects. Five patients presented after bowel resection, three with recurrent sacral pressure sores. The average follow-up was 12 months. Postoperatively, all patients were allowed to be prone on the operated area. One minor wound dehiscence was sutured in local anesthesia. CT imaging analysis of the pelvis showed complete void space coverage. The combined latissimus dorsi and serratus anterior flaps are a valuable tool for pelvic reconstruction in our hands. In addition, severe atherosclerosis should not be considered an obstacle to microsurgery and the use of free flaps.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hand and Burn Surgery, University Hospital Köln-Merheim, University Witten-Herdecke, Germany.
authors.forename: Truong Q V
authors.initials: TQ
authors.lastname: Phan
authors.forename: Gerald
authors.initials: G
authors.lastname: Spilker
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodorou
authors.forename: Andreas
authors.initials: A
authors.lastname: Gossmann
authors.forename: Michael
authors.initials: M
authors.lastname: Heiss
authors.forename: Christian
authors.initials: C
authors.lastname: Weinand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000601:surgery; D003668:Pressure Ulcer / Q000150:complications / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012445:Sacrococcygeal Region