Double skin perforator flaps for aesthetic resurfacing of extensive limb defects

Abstract

Microsurgical tissue transfer is regarded as an ideal method for complex and large defects, especially in head and neck reconstruction, which requires multiple components such as bone and soft tissues. These situations often require a double free flap technique using an anterolateral thigh flap along with a fibular flap or radial forearm flap plus an anterolateral thigh flap for 3 dimensional reconstruction.1, 2 and 3 However these effective methodologies are not popular especially for extremity reconstruction, and there is a lack of knowledge of the use of double skin flaps for extensive defects of the extremities. This concept is useful for aesthetic limb resurfacing. In this article, we describe 6 cases in which we employed a latissimus dorsi perforator (LDp) flap together with a deep inferior epigastric artery perforator (DIEP) or anterolateral thigh perforator flap (ALT). The Latissimus dorsi perforator flap was used as a link or vascular conduit flap which means that a second flap pedicle from, for example, a serratus anterior vessels or circumflex scapular vessels was anastomosed to the latissimus dorsi perforator pedicle. Therefore when we harvested the latissimus dorsi perforator flap, we include the subscapular arterial system including the serratus anterior branch and circumflex scapular vessel branches. Several vascular branches were ligated to obtain a longer vascular pedicle. For microanastomosis to the serratus anterior branch or circumflex scapular vessels, the vessels harvested should be as long as possible. All the latissimus dorsi perforator flaps were free flaps except in one case in which we used a pedicled latissimus dorsi perforator flap to resurface an upper arm. Three of the second flaps were deep inferior epigastric artery perforator flaps and three were anterolateral thigh flaps. All the donor sites were closed primarily.