الفهرس | Only 14 pages are availabe for public view |
Abstract The advent of free tissue transfer has provided multiple options for difficult soft tissue defects of the lower extremity that allow the preservation and maintain the functional and aesthetic status of the limb. Since the first report of the latissimus dorsi flap by Tansini i1896, it has become one of the most commonly used flaps in reconstruction of various soft tissue defects. The flap has gained popularity because it has a large muscle surface area, can be elevated with a considerable skin paddle, and has a long and wide vascular pedicle with consistent anatomy and acceptable donor site morbidity and the thickness of the flap can be adjusted. In this thesis, a study was done to evaluate the indications, advantages, disadvantages, and complications of reconstruction of complex soft tissue defects in the lower extremities using free latissimus dorsi muscle flap. The study was carried out on 16 patients with complex soft tissue defects of the lower extremities (12 males and 4 females), their age ranged from 7 to 55 years. The causes of the soft tissue defects were trauma, unstable graft, osteomyelitis and soft tissue sarcoma. The site of the defect was at the middle and lower thirds of the leg in 5 patients, at lower third leg and ankle in 8 patients, at dorsum of foot in 2 patients and at sole of foot in 1 patient. The average number of debridement sessions before definitive coverage was 1.4 times per patient. The average time of definitive coverage in trauma patients was 7 days post trauma and more than 6 months in other causes. The mean duration of the operation was 6.2±1.3 hours. The microvascular anastomosis was done to the anterior tibial vessels in 5 patients and to the posterior tibial vessels in 11 patients. A total of 15 flaps (93.75%) survived completely, and one flap (6.25%) totally lost due to venous thrombosis. Recipient site complications include hematoma under the flap in one patient (6.25%), wound infection in 4 patients (25%), osteomyelitis in 1 patient (6.25%), and patchy skin graft losses in 7 patients (43.75%). Donor site complications included seroma in 4 patients (25%), hematoma in 1 patient (6.25%), major wound dehiscence in1 patient (6.25%), minor wound dehiscence in2 patients (12.5%) and wound infection in 1 patient (6.25%). The patients during their average one year follow up showed no significant limitation of shoulder mobility, with nearly equal mobility of both shoulders. The reconstructed recipient sites were pain free with adequately accepted appearance on the average. |