title: What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.
abstract: Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea; and †Department of Plastic and Reconstructive Surgery, Seoul National University, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
authors.forename: Seungki
authors.initials: S
authors.lastname: Youn
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery; D064171:Superficial Back Muscles / Q000637:transplantation*; D013997:Time Factors; D020858:Tissue and Organ Harvesting