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

Closure of tissue defects after surgical interventions applied to the lumbosacral region appears as a challenging procedure. Latissimus 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.

Geniþ Lumbosakral Defektin Reverse Turnover Latissimus Dorsi Kas Flebi ve Bilateral Bipediküllü Flep ile Onarýmý: Vaka Sunumu

Lumbosakral bolgeye uygulanan cerrahi girisimler sonrasi olusan doku defektlerinin kapatilmasi zorlayici bir prosedur olarak karsimiza cikmaktadir.Latissimus dorsi kas flebi de lumbosakral defektler icin siklikla kullanilan flepler arasindadir.Defekt yerine gore latissimus dorsi kasi major pedikulu olan torakodorsal arter ve ven uzerinden kaldirilabilecegi gibi segmental pedikuller olan interkostal arter perforatorleri uzerinden de kaldirilabilir.Segmental pedikul uzeinden cevrilen latissimus dorsi kas flebi sik kullanilmamakla beraber kapatimi icin fazla alternatifi olmayan lumbosakral defektlerin kapatiminda cok yararlidir.Bu calismamizda skolyoz sebebiyle daha once opere olan ve sirt orta hatta fiksator ekspoze doku defekti olan hastanin reverse turnover latissimus dorsi kas flebi ve bilateral bipedikullu cilt flebi ile rekonstruksyonu olgusu sunulmaktadir. Skolyoz deformitesi olan 35 yasinda kadin hasta Daha once 1 yasinda skolyoz sebebiyle opere olmus.Yaklasik 1 sene once de dis merkezde revizyona ihtiyac duyulmus yeni fikasotorler konmus.Sonrasinda fiksator ekspoze doku defekti gelisen hasta 3 kere debridmana alinmis ve VAC tedavisi gormus.Defektinin kapanmamasi uzerine tarafimiza yonlendirilen hastaya reverse turnover latissimus dorsi kas flebi ve bilateral bipedikullu cilt flebi ile rekonstruksyon yapildi.Hastaya operasyon sirasinda uygulanan islemler ve postoperatif takip sonuclari irdelendi. "ters" veya "distal bazli" latissimus dorsi flepleri olarak adlandirilan sekonder segmental damarlara dayali latissimus dorsi flepleri, spinal,lomber ve ust sakral bolgelerin defektlerini onarmak icin kullanilmistir.Cogu olguda cilt kismi gerekli olmamakla beraber kas flebi olarak kaldirilir ve transpozisyon tavriyla yapilir. Latissimus dorsi kasinin reverse turnover flebi, mikrovaskuler anastomoz olmaksizin, lomber bolgenin buyuk defektlerinin basarili bir sekilde onarilmasini saglar. (SETB-2018-08-114)