Closure of a Large Lumbosacral Defect with Reverse Turnover Latissimus Dorsi Muscle Flap and Bilateral Bipedicle Flap: A Case Report

• Published in: Şişli Etfal Hastanesi tıp bülteni Vol. 54; no. 3; pp. 380 - 383
• Main Authors: Gunenc, Ali Can, Sevim, Kamuran Zeynep, Ertas, Yunus, Albayrak, Akif, Irmak, Fatih
• Format: Journal Article
• Language: English
• Published: Turkey Kare Publishing 01.01.2020
• Subjects: Case Report; Case reports; Defects; Scoliosis; Latissimus dorsi flap; lumbosacral defect; scoliosis
• ISSN: 1302-7123; 1308-5123
• DOI: 10.14744/SEMB.2018.81542

dorsi muscle flap is also among the frequently used flaps for lum-bosacral defects. According to the defect, the latissimus dorsi muscle can be elevated as a major pedi-cle from over the thoracodorsal artery and vein, as well as segmental pedicles from over the intercostal artery perforators. Latissimus dorsi muscle flap elevated as a segmental pedicle is not frequently used; however, it is very useful in closing lumbosacral defects that do not have many alternatives for their closure. In this study, a case of reconstruction with reverse turnover latissimus dorsi muscle flap and bilateral bipedicle skin flap of a patient, who was previously operated due to scoliosis and had tissue defect with the exposed fixator in the midline back. A 35-year-old female patient with scoliosis de-formity was previously operated due to scoliosis when she was 1-year old. About one year ago, a revision was required and new fixators were placed at an external center. Afterwards, the patient who developed tissue defect with the exposed fixator underwent debridement three times and vacuum-assisted closure (VAC) device treatment was performed. The patient, who was referred to us due to the defect which was not closing, was reconstructed with reverse turnover latissimus dorsi muscle flap and bilateral bipedicle skin flap. The procedures applied during the operation and postoperative follow-up results were examined. Latissimus dorsi flaps resting on secondary segmental vessels, which are named as "reverse" or "distal-based" latissimus dorsi flaps, were used to repair defects of spinal, lumbar and upper sacral regions. In most cases, the skin is not required and it is transferred as a muscle flap, and is performed as a transposition flap. The reverse turnover latissimus dorsi muscle flap ensures the successful repair of large defects of the lumbar region without microvascular anasto-mosis.