Baharuddin, Shariza
(2015)
Skin paddle and donor site morbidity of myocutaneous latissimus dorsi free flap for reconstruction of large defect.
Masters thesis, Universiti Sains Malaysia.
Abstract
Myocutaneous Latissimus Dorsi (MCLD) Free Flap has been widely used for
reconstructive purpose as it reliable, fairly easy to perform and is believed to have
minimal donor site morbidity. We aim to study the effect of raising large skin paddle of
MCLD free flap by analyzing the complication of donor and recipient site. Other factors
that might affect the complication were also studied.
A retrospective study of all consecutive patients operated between 2000 until
2012 that required MCLD free flap was performed. Demographic data, operative details
and complications were examined. The QuickDASH questionnaire was performed in
patient who was still under follow up and by doing telephone interview to assess the
upper limb function.
A total of 86 cases were studied (27 women and 59 men) with average age of 32
years old (5 years to 69 years). The most common aetiology for reconstruction was
malignancy (48.8%) and trauma (38.4%). The MCLD free flap was mostly used for
reconstruction of lower extremity. The mean skin paddle width was 8.01 cm (4cm to 14
cm) and the mean skin paddle size was 206.1cm2 (45cm2 to 440 cm2).
Donor complications occurred in 18% cases which include wound breakdown,
seroma and blisters formation. There was no significant factor that was found to have
association with the development of donor complication. Recipient complication occurs
in 48% of cases. Factors that have significant association with development of recipient
complication were flap re-exploration (p=0.01), presence of vascular injury (p= 0.01) and
long operative time (p=0.02). A total of 22 patients answered the QuickDash
questionnaire. There were no significant different between size of skin paddle with
limitation of shoulder function.
In conclusion, reconstruction of large defect with Myocutaneous Latissimus Dorsi
Free flap, the size and width of skin paddle has no significant association with donor or
recipient complications. However, there were significant association between presence
of vascular injury, long operative time and flap re-exploration with development of
recipient complication.
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