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

Özet

Closure of tissue defects after surgical interventions applied to the lumbosacral region appears as a challenging procedure. Latissimusdorsi muscle flap is also among the frequently used flaps for lum-bosacral defects. According to the defect, the latissimusdorsi muscle can be elevated as a major pedi-cle from over the thoracodorsal artery and vein, as well as segmental pedicles fromover 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 ofreconstruction with reverse turnover latissimus dorsi muscle flap and bilateral bipedicle skin flap of a patient, who was previouslyoperated due to scoliosis and had tissue defect with the exposed fixator in the midline back. A 35-year-old female patient withscoliosis de-formity was previously operated due to scoliosis when she was 1-year old. About one year ago, a revision was requiredand new fixators were placed at an external center. Afterwards, the patient who developed tissue defect with the exposed fixatorunderwent debridement three times and vacuum-assisted closure (VAC) device treatment was performed. The patient, who wasreferred to us due to the defect which was not closing, was reconstructed with reverse turnover latissimus dorsi muscle flap andbilateral 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 transferredas a muscle flap, and is performed as a transposition flap. The reverse turnover latissimus dorsi muscle flap ensures the successfulrepair of large defects of the lumbar region without microvascular anasto-mosis.