Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps.

BACKGROUND: In patients with underlying vasculopathies, the unavailability of main vessels for conventional microsurgery may preclude limb salvage. However, with the evolution of supermicrosurgical techniques, anastomosis at the perforator level that is almost always spared by the underlying disease has become possible. To overcome insufficient flow in large flap issues following the procedure, a supercharging technique was used in reconstructions using a latissimus dorsi perforator free flap.
METHODS: From January of 2008 to June of 2010, a total of 21 patients underwent reconstructive procedures for large defects of the lower extremities using supermicrosurgery with arterial and/or venous supercharging techniques, including a latissimus dorsi perforator, an intercostal perforator, and the lateral thoracic vein.
RESULTS: All flaps survived completely without arterial or venous problems. There were three minor complications of infection, venous congestion, and donor-site hematoma. Except for a hematoma evacuation procedure, complications were managed conservatively.
CONCLUSIONS: : The latissimus dorsi perforator flap can be harvested with numerous latissimus dorsi perforators, intercostal perforators, and the lateral thoracic vein to perform the supercharging technique on reconstruction of large foot defects in patients with severe vasculopathy. This technique can be applied in various difficult situations, including traumatic injury of the main limb vessels, and can increase survival rates for limb salvage, particularly in ischemic limb reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.