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J Hand Microsurg 2023; 15(01): 053-058
DOI: 10.1055/s-0041-1726620
Original Article

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

David J. Cinats 
1   Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, United States
,
Brian J. Harley
2   Department of Orthopaedic Surgery, SUNY Upstate Medical University, Syracuse, New York, United States
,
Jon B. Loftus
2   Department of Orthopaedic Surgery, SUNY Upstate Medical University, Syracuse, New York, United States
› Author Affiliations Funding None.
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Abstract

Introduction Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure.

Materials and Methods A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery.

Results Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6–20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2–4). Mean wound size was 189 cm2 with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes.

Conclusion Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.

Keywords

spine - wound dehiscence - arteriovenous loop - latissimus free flap


Publication History

Article published online:
23 March 2021

© 2021. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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