Spiegel Gilad, Yabuno Yuto, Umezawa Hiroki, Kondo Akatsuki, Ogawa Rei
From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
Plast Reconstr Surg Glob Open. 2025 Mar 12;13(3):e6589. doi: 10.1097/GOX.0000000000006589. eCollection 2025 Mar.
Latissimus dorsi (LD) flaps are ideal for reconstructing deep and complex anterolateral chest defects because they provide both coverage and volume with relatively short surgery and acceptable donor-site morbidity. The LD flap is suitable for patients who have undergone lung surgery and should avoid prolonged or invasive reconstruction surgery. However, the LD main pedicle, the thoracodorsal artery (TDA), is often damaged in these patients. A hitherto poorly known alternative is an LD flap that is based on a posterior intercostal artery perforator (P-ICAP). Here, we present the case of a 65-year-old man with a postpleurectomy anterolateral chest defect involving exposed lung tissue who was planned to undergo reconstruction with an ipsilateral TDA-pedicled musculocutaneous LD flap. In preoperative imaging and intraoperative exploration, the TDA was found to be damaged, but the eighth dorsal branch P-ICAP was identified and shown to have a strong Doppler signal. Thus, it served as the pedicle, and the entire LD muscle was elevated. The cutaneous part of the flap was designed as a superoposteriorly based transposition flap that maintained a skin bridge to reduce the risk of venous congestion. The donor site was closed primarily. The postoperative course was uneventful. This case supports the use of a P-ICAP-based LD musculocutaneous flap for reconstructing anterolateral chest defects in cases where the TDA is damaged.
背阔肌（LD）皮瓣是修复前胸壁深部复杂缺损的理想选择，因为它能在相对较短的手术时间内提供覆盖和填充，且供区并发症可接受。LD皮瓣适用于接受过肺部手术且应避免长时间或侵入性重建手术的患者。然而，这些患者的LD主要蒂部，即胸背动脉（TDA），常受到损伤。一种迄今鲜为人知的替代方法是基于后肋间动脉穿支（P-ICAP）的LD皮瓣。在此，我们报告一例65岁男性患者，其胸膜切除术后前胸壁缺损，伴有暴露的肺组织，计划采用同侧TDA蒂的肌皮LD皮瓣进行重建。在术前影像学检查和术中探查中，发现TDA受损，但识别出第八肋间背支P-ICAP并显示其具有强烈的多普勒信号。因此，将其作为蒂部，掀起整个LD肌。皮瓣的皮肤部分设计为基于后上方的移位皮瓣，保留皮肤桥以降低静脉淤血的风险。供区直接缝合。术后过程顺利。该病例支持在TDA受损的情况下，使用基于P-ICAP的LD肌皮瓣修复前胸壁缺损。
