Supermicrosurgical Reconstruction of Large Defects on Ischemic Extremities using Supercharging Techniques on Latissimus Dorsi Perforator Flaps

INTRODUCTION : Though the supermicrosurgery provides wider option for choosing recipient vessels and saving operation time^1,2, it still remains the risk for flap failure. To overcome this, we present supermicrosurgery with supercharging technique using latissimus dorsi perforator flaps.

PATIENTS AND METHODS : From January of 2008 to June of 2010, 21 patients with defects of lower extremity due to diabetes mellitus(15 cases), atherosclerotic obliterans(1 cases), and rheumatoid disease(5 case), underwent flap coverage. At least 2 perforators were included in the flap, which are latissimus dorsi perforators, thoracodorsal perforators, or intercostal perforators. The flap was detached at the level of the perforator with sparing main source vessel, and anastomosed to terminal branches or perforators of recipient site in end to end fashion. The diameter of all recipient vessels was less than 1mm.

RESULTS : As all the cases had segmental obstruction of major vessel on lower extremity, conventional flap with anastomosis to main vessels were not suitable. 21 latissimus dorsi perforators based free flaps with superchaging technique were performed, and all the flaps survived completely without arterial or venous problems. Among 21 flaps, 17 flaps included 2 perforators, and 2 flaps included 3 perforators. In the other 2 cases, extra perforators were not included, but lateral thoracic vein was added for venous supercharging.

CONCLUSION : Latissimus dorsi perforator flap with supermicrosurgery is well suited for reconstruction of foot defect in severe vasculopathic patients, and with supercharging technique, large defect coverage is available³. This method is useful in increasing survival rates of ischemic limb reconstruction.

Reference

1. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg. 2009;123:230-235

2. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg. 2010;64:291-293

3. Sano K, Hallock GG, Rice DC. Venous "supercharging" augments survival of the delayed rat TRAM flap. Ann Plast Surg. 2003;51 :398-402.