Yotsuya Medical Cube, Chiyoda-ku, Tokyo, Japan
Exposure of blood vessels or nerves of the medial elbow, or exposure of the bone of the lateral elbow must be covered using a skin flap. Although a number of either normal flow or reverse flow vascularized flaps can be created in the elbow region, in many cases blood vessel damage is also present, and there are often restrictions on the size of the flap, so focusing only on the upper arm can make surgery more difficult. In spite of large dissection, a vascularized latissimus dorsi flap is stable and practical.
With skin graft using negative pressure wound therapy, because the elbow is not required to be fixed in place, there is less chance of contracture occurring, and even when graft conditions are poor, there is a high ratio of the graft taking, making it extremely practical.
Selectable Flaps and Surgical ProceduresPedicled latissimus dorsi musculocutaneous flapSkin graft pressure method using negative pressure wound therapy
The difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.
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1.1 Pedicled Latissimus Dorsi Musculocutaneous Flap (Level of Difficulty: 3)
Vascular pedicle thoracodorsal blood vessel (the circumflex scapular artery is ligated and detachment continued up to the subscapular blood vessels)
Size (muscle flap) width of 40 cm and length of 40 cm; if thoracolumbar fascia is included, it is possible to harvest the entire 60 cm length
Advantage Good circulation, vascular pedicle is large and long, technique is comparatively easy. Can freely design skin on muscle flap
Disadvantage Large dissection area, and large amount of blood loss. Cases with a thick layer of fat over the latissimus dorsi muscle causes bulkiness preventing it from being used as a musculocutaneous flap, and therefore a skin graft is required (1.5 times mesh skin graft)
Caution The muscle head is also cut, creating a complete muscle island flap. Do not use an electrical scalpel after cutting the muscle ends. The space following removal of the latissimus dorsi muscle can cause a painful seroma, so several continuous suction drains should be put in place.
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