The Role of Pedicled Latissimus Dorsi Flap in Scalp Defect Reconstruction Following Tumour Excision
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The Role of Pedicled Latissimus Dorsi Flap in Scalp Defect Reconstruction Following Tumour Excision Kunal Ranjan1 • Vinay Venkataramu1 • Hari Prasad Achanti2 • Shruti Khemka1 Ashok Mohan Shenoy1 • Mitali Dandekar1
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Received: 25 July 2020 / Accepted: 17 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Scalp is a common site for skin tumors mainly squamous cell carcinoma and basal cell carcinoma. It is always challenging to reconstruct the scalp defect following tumor excision. Conventional methods of skin grafting or rotation flap is not always feasible for large scalp defect. This paper presents the author’s experience in 3 patients of scalp tumors in which conventional methods were not sufficient to reconstruct the defect, hence pedicled latissimus dorsi flap was used considering the flap size to cover the defect and reach needed for the pedicled flap. In all the 3 cases latissimus dorsi myocutaneous was able to reach the defect site and cover the large scalp defect area; thereby serving as an alternative to free flap which is technically more challenging, skill based and less feasible in normal surgical settings. Keywords Scalp Latissimus dorsi Flap Pedicled
& Kunal Ranjan [email protected] Vinay Venkataramu [email protected] Hari Prasad Achanti [email protected] Shruti Khemka [email protected] Ashok Mohan Shenoy [email protected] Mitali Dandekar [email protected] 1
Department of Head and Neck Surgery, Mahavir Cancer Sansthan, Patna, Bihar, India
2
Mahavir Cancer Sansthan Patna, Patna, Bihar, India
Introduction Scalp defect following tumor resection can be either closed by split skin graft or by scalp rotation flap. In large defects where pericranium has been resected with tumor margin a pedicled flap or free flap is indicated. The intrinsic problem with pedicled flap in scalp reconstruction is the reach of the flap that becomes more obvious when the defect lies on the top or posterolateral part of the scalp. In reconstruction like should be replaced by like. Composite tissue transfer should have the ability to withstand the mechanical stress generated in the area [1, 2]. Although various flaps have been used in scalp reconstruction like radial forearm [3], anterolateral thigh [4]. Free flap is not done in every surgical setup. There is restriction in reach as well in size of flap in scalp region while using other pedicled flaps like Pectoralis major flap, trapezius flap etc. Unlike them latissimus dorsi flap has the advantage of being versatile providing large tissue surface for reconstruction and when pedicled can reach upper face and scalp. Purpose of this study is to demonstrate the utility of latissimus dorsi flap, its size and any complications. Surgical Anatomy It is a large V shaped triangular muscle arising from the sacrum, lumbar vertebrae, posterior iliac crest, thoracolumbar fascia and lower six thoracic vertebrae and inserts into the intertubercular groove of humerus. Vascular supply arises from the thoracodorsal ves
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