The Reconstructive and Functional Role of Latissimus Dorsi Flap in Complex Upper Extremity Injuries

Severe upper extremity injuries are considered a potential source of significant disability. Appropriate soft tissue restoration is an essential component of any treatment protocol and often requires a vascularized flap to protect the neurovascular and musculo-tendinous structures. The use of latissimus dorsi muscle or myocutaneous flap is considered in ideal solution in such conditions as it provides reliable, well-vascularized soft tissue coverage to an extensive surface area. Also, it could provide a functional unit, as well, to compensate for flexion or extension deficits at the elbow resulting from traumatic loss of the effective muscle power for elbow flexion or extension. Latissimus dorsi pedicled muscle or myocutaneous flap were used for immediate soft tissue coverage in twenty-three patients with complex upper extremity injuries involving the arm and elbow. The muscle flap was used as a functional unit for elbow reanimation in 5 patients. The results were satisfactory with accelerated postoperative recovery and return of functional activity. Limb salvage were achieved in all patients except one with vascular graft occlusion necessitated above elbow amputation. The advantages of immediate coverage of such defects with latissimus dorsi flap were appreciated and it was concluded that this flap could be considered the flap of choice for such defect.