title: An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect.
abstract: OBJECTIVE
  Treatment of non-healing wounds of lower back often poses a powerful challenge. We present one of the first report of treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle.
  
  
  METHODS
  We report a case of a 59 year-old man with myeloma of the sacral spine who underwent radiotherapy and chemotherapy and subsequently, laminectomies and placement of hardware for ongoing paresis and spine instability. Then, he developed an open wound and osteomyelitis of the spine with culture positive tuberculous granulomas. After multiple surgical debridement, he presented to our service and was treated with a single stage debridement followed by the performance of a latissimus dorsi musculocutaneous flap based on paraspinal perforators and supercharged.
  
  
  RESULTS
  This solution, allowed for augmentation of blood flow to the muscle with the inferior gluteal artery, provided coverage of the defect resistant to the pressure, and simplified post-operative management of the patient.
  
  
  CONCLUSIONS
  Alternative treatment options, including free tissue transfer, posed difficulties in finding suitable recipient vessels near the defect, in inserting the flap so as to restore its original length without compromising blood flow, and in postoperative care of the patient. Treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle may represent a milestone procedure for complicated lower spine wounds.
authors: Department of Plastic Surgery, and the E-Da Hospital/I-Shou University, Taiwan. ida.ponzo@hotmail.it.
authors: E
authors: E
authors: Cigna
authors: S
authors: S
authors: Mardini
authors: H-C
authors: HC
authors: Chen
authors: Ö
authors: Ö
authors: Özkan
authors: P
authors: P
authors: Sassu
authors: C J
authors: CJ
authors: Salgado
authors: Y-T
authors: YT
authors: Lieu
authors: I
authors: I
authors: Ponzo
authors: D
authors: D
authors: Ribuffo
authors: N
authors: N
authors: Scuderi
mesh_terms: D003646:Debridement / Q000379:methods; D019468:Disease Management; D006801:Humans; D008161:Lumbosacral Region / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation / Q000379:methods*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps