Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zhiyuan ,  TANG Xiujun , WANG Dali , WEI Zairong , JIN Wenhu , DENG Chengliang , QI Jianping

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China;

Corresponding author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Latissimus dorsi muscle flap; Kiss flap; deltoid; functional reconstruction; wound repair

DOI：

10.7507/1002-1892.201704047

Video：

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Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S₁ in 2 cases, S₂ in 6 cases, S₃ in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.

Citation： LIU Zhiyuan, TANG Xiujun, WANG Dali, WEI Zairong, JIN Wenhu, DENG Chengliang, QI Jianping. Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1106-1110. doi: 10.7507/1002-1892.201704047 Copy

1.	任高宏, 胡稷杰, 裴国献. 倒" Y”形血管吻合游离皮瓣移植在肢体创面修复与功能重建中的应用. 中华显微外科杂志, 2012, 35(1): 27-31.
2.	赵茹, 乔群, 柳成, 等. 背阔肌分区的解剖及临床应用. 中国修复重建外科杂志, 2003, 17(1): 38-40.
3.	沈余明, 马春旭, 胡骁骅, 等. 膝关节周围严重皮肤软组织缺损的组织瓣修复策略. 中华烧伤杂志, 2015, 31(5): 331-336.
4.	Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsimyocutaneous flap in breastreconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5.	彭涛, 刘元波, 臧梦青, 等. 联合多个预扩张带蒂轴型皮瓣修复上肢大面积皮肤软组织缺损的临床应用. 中华美容整形外科杂志, 2015, 26(10): 620-624.
6.	Zhang YX, Hayakawa TJ, Levin LS, et al. The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7.	Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
8.	吕春柳, 李赞, 周晓, 等. 带蒂背阔肌 Kiss 皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
9.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10.	Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
11.	Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
12.	Hwang JH, Kim ES, Kim KS, et al. Latissimus dorsi muscle and its short perforator-based skin compound free flap. Ann Plast Surg, 2007, 58(4): 381-387.
13.	梁尊鸿, 潘云川, 林志琥. 带蒂背阔肌肌皮瓣早期修复颈部电烧伤深度创面. 组织工程与重建外科杂志, 2016, 12(5): 297-299.
14.	唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科志, 2006, 20(11): 1087-1089.
15.	胡祖良, 张元海, 倪良方, 等. 带蒂背阔肌皮瓣转移修复 Ⅳ 度烧伤创面. 浙江临床医学, 2016, 18(3): 469-450.
16.	韦平欧, 谭海涛, 江建中, 等. 背阔肌皮瓣移植重建屈肘屈指功能 11 例. 中华显微外科志, 2011, 34(6): 494-495.
17.	Boa O, Servant JM, Revol M, et al. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction. Tech Hand Up Extrem Surg, 2011, 15(3): 166-171.
18.	Muramatsu K, Ihara K, Tominaga Y, et al. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthet Surg, 2014, 67(7): 916-920.
19.	Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg, 1986, 78(3): 336-344.
20.	李钢, 李小兵, 刘子健, 等. 背阔肌肌皮瓣修复肩部皮肤及三角肌缺损十例. 中华烧伤杂志, 2014, 30(4): 370-372.
21.	Dancey AL, Cbeema M, Thonmas SS, et al. A prospective randomized trial of the efficacy of marginal quitting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
22.	Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
23.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
24.	王欣, 潘佳栋, 胡皓良, 等. 分叶型穿支皮瓣在四肢皮肤软组织缺损修复中的临床应用. 中华显微外科杂志, 2013, 36(4): 327-330.
25.	王朝阳, 章一新, 王丹茹, 等. 双叶背阔肌肌皮瓣修复大面积深部组织缺损. 上海交通大学学报(医学版), 2012, 32(5): 633-637.
26.	唐修俊, 魏在荣, 王波, 等. 游离旋股外侧动脉穿支 KISS 皮瓣修复四肢创面的临床应用. 中华显微外科杂志, 2015, 38(1): 29-32.

1. 任高宏, 胡稷杰, 裴国献. 倒" Y”形血管吻合游离皮瓣移植在肢体创面修复与功能重建中的应用. 中华显微外科杂志, 2012, 35(1): 27-31.
2. 赵茹, 乔群, 柳成, 等. 背阔肌分区的解剖及临床应用. 中国修复重建外科杂志, 2003, 17(1): 38-40.
3. 沈余明, 马春旭, 胡骁骅, 等. 膝关节周围严重皮肤软组织缺损的组织瓣修复策略. 中华烧伤杂志, 2015, 31(5): 331-336.
4. Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsimyocutaneous flap in breastreconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
5. 彭涛, 刘元波, 臧梦青, 等. 联合多个预扩张带蒂轴型皮瓣修复上肢大面积皮肤软组织缺损的临床应用. 中华美容整形外科杂志, 2015, 26(10): 620-624.
6. Zhang YX, Hayakawa TJ, Levin LS, et al. The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7. Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
8. 吕春柳, 李赞, 周晓, 等. 带蒂背阔肌 Kiss 皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
9. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10. Watanabe K, Kiyokawa K, Rikimaru H, et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg, 2010, 63(7): 1091-1098.
11. Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
12. Hwang JH, Kim ES, Kim KS, et al. Latissimus dorsi muscle and its short perforator-based skin compound free flap. Ann Plast Surg, 2007, 58(4): 381-387.
13. 梁尊鸿, 潘云川, 林志琥. 带蒂背阔肌肌皮瓣早期修复颈部电烧伤深度创面. 组织工程与重建外科杂志, 2016, 12(5): 297-299.
14. 唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科志, 2006, 20(11): 1087-1089.
15. 胡祖良, 张元海, 倪良方, 等. 带蒂背阔肌皮瓣转移修复 Ⅳ 度烧伤创面. 浙江临床医学, 2016, 18(3): 469-450.
16. 韦平欧, 谭海涛, 江建中, 等. 背阔肌皮瓣移植重建屈肘屈指功能 11 例. 中华显微外科志, 2011, 34(6): 494-495.
17. Boa O, Servant JM, Revol M, et al. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction. Tech Hand Up Extrem Surg, 2011, 15(3): 166-171.
18. Muramatsu K, Ihara K, Tominaga Y, et al. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthet Surg, 2014, 67(7): 916-920.
19. Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg, 1986, 78(3): 336-344.
20. 李钢, 李小兵, 刘子健, 等. 背阔肌肌皮瓣修复肩部皮肤及三角肌缺损十例. 中华烧伤杂志, 2014, 30(4): 370-372.
21. Dancey AL, Cbeema M, Thonmas SS, et al. A prospective randomized trial of the efficacy of marginal quitting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg, 2010, 125(5): 1309-1317.
22. Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
23. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
24. 王欣, 潘佳栋, 胡皓良, 等. 分叶型穿支皮瓣在四肢皮肤软组织缺损修复中的临床应用. 中华显微外科杂志, 2013, 36(4): 327-330.
25. 王朝阳, 章一新, 王丹茹, 等. 双叶背阔肌肌皮瓣修复大面积深部组织缺损. 上海交通大学学报(医学版), 2012, 32(5): 633-637.
26. 唐修俊, 魏在荣, 王波, 等. 游离旋股外侧动脉穿支 KISS 皮瓣修复四肢创面的临床应用. 中华显微外科杂志, 2015, 38(1): 29-32.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap

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