Comment-Box Modification to Muscle-Sparing Latissimus Dorsi Design for Microvascular Anastomosis Coverage
نویسندگان
چکیده
1 F autologous reconstruction introduces added complexity to wound coverage. Flaps based on the descending branch (DB) of the thoracodorsal artery can provide a combination of muscle, skin, or bone to wound all the while providing significant pedicle length. With the placement of a microvascular anastomosis outside of a zone of injury, pedicle management is paramount and is often not considered until toward the last hours of a case when surgeon fatigue is an issue. In areas of tenuous skin coverage such as the scalp or distal lower extremity where the defect can be part of a convex surface anatomy, traditional management such as subcutaneous tunneling or primary closure with overlying edematous, fibrotic tissue compresses the anastomosis. Skin grafting leaves the pedicle exposed, may compromise aesthetics, and carries the morbidity of an added donor site. Our “Comment Box” modification introduces additional cutaneous tissue and prompts the surgeon to consider pedicle coverage at the outset of the case. Intraoperatively, careful measurements of the soft tissue requirements of the wound itself and the planned site of anastomosis are performed. After pedicle length requirement are ascertained, we begin harvest of the Comment Box flap (Fig. 1). The tail of the Comment Box is oriented along the anterior LD border within the cuta-
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