title: Coverage of Amputation Stumps Using a Latissimus Dorsi Flap With a Serratus Anterior Muscle Flap: A Comparative Study.
abstract: Amputation of the extremities is a definitive reconstructive option, and surgeons should aim to preserve maximum overall function. If the exposed bone cannot be adequately covered using local tissues, the stump can be reconstructed using a number of well-described free flap transfer techniques. Between January 2002 and December 2011, 31 patients with severe injuries to the lower extremities underwent above-the-knee, below-the-knee, and Chopart and Ray amputations. Bony stumps were covered using latissimus dorsi myocutaneous flaps alone (group 1), or together with serratus anterior muscle flaps (group 2). The groups were compared with respect to age, flap survival, skin flap size, immediate complications, wound sloughing, deep ulceration, need for bone amputation, limb visual analog scale score, time to prosthesis, and follow-up duration. The mean area of the latissimus dorsi skin flap was 255.9 cm, and immediate complications occurred in 8 (25.8%) patients. In the double-padding group, there were fewer cases of deep ulceration than in the single-flap group, and prostheses could be worn sooner. There were no statistically significant differences in other parameters. Successful reconstruction of amputation stumps requires an adequate, durable, weight-bearing, and well-contoured soft tissue cover. A latissimus dorsi musculocutaneous flap together with a serratus anterior muscle flap provides well-vascularized muscle tissue and a durable skin paddle, leading to less ulceration than conventional flap techniques.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Seoul National University, College of Medicine, Seoul National University Hospital; Departments of †Plastic and Reconstructive Surgery, and ‡Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Jeon
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000672:Amputation Stumps / Q000601:surgery*; D000673:Amputation, Traumatic / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D064169:Intermediate Back Muscles / Q000601:surgery / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D010147:Pain Measurement; D019651:Plastic Surgery Procedures / Q000379:methods; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D064171:Superficial Back Muscles / Q000601:surgery / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*