Role of Latissimus Dorsi Island Flap in Coverage of Mutilating Upper Limb Injuries in Pediatric Age Group

Abstract

Background/Purpose: Latissimus dorsi muscle (LDM) is one of the most versatile muscles that is commonly used in different reconstructive procedures. Severe mutilating injuries of the upper limb in children represent a great challenge to reconstructive surgeons especially when important structures become exposed. Materials & Methods: we utilized LDM as an island flap to cover extensive soft tissue defects in the upper limb of pediatric patients. This work included 17 children (13 males and 4 females). All of them had extensive soft tissue loss of the upper limb with exposure of important structures. The cause of injury was road traffic accident in all patients. We analyzed the operative time, need for multi-stage surgery and the recorded complications. Finally, we recorded the ultimate functional and aesthetic outcome after a period of two years of follow up. Results: From the harvested seventeen flaps, none of them was lost. Split thickness skin graft was done one week after flap harvesting and insetting to cover the muscle flap. There were four cases with partial loss of the skin graft secondary to infection. Those four cases needed re-grafting after eradication of infection that needed almost two weeks of local wound care and dressing. Re-grafting was successful in the four cases. Conclusion: For complex upper extremity wounds in the pediatric age group, we advice aggressive debridement and early reconstruction with LDM pedicle flap with a split-thickness skin graft cover over it. The technique is reliable, with minimal donor site morbidity and very accepted functional and cosmetic outcome.

Index Word: Latissimus dorsi muscle flap, complex trauma, pediatric age group.