The Modified Extended Fleur-De-Lis Latissimus Dorsi Flap for Various Complex Multi-directional Large Soft and Bone Tissue Reconstruction

Introduction Latissimus Dorsi (LD) myocutaneous flap is a workhorse flap for various large reconstructions. Variants described to increase its volume are referred to as extended LD flaps. The extended fleur-de-lis LD is one of these variants. We report the clinical outcomes using a modified extended fleur-de-lis LD flap for complex multi-directional soft and bone tissue defects. Methods Between 2010 and 2017, 29 patients underwent the modified extended fleur-de-lis LD flaps, whose sizes were between 120 cm(2 )and 442 cm(2). The mean age was 47.55 ± 9.07 years. Locations of the defects included head and neck (nine cases), upper extremity (six cases), lower extremity (nine cases) and chest wall regions (five cases). Results Of the 29 extended fleur-de-lis LD flaps, 11 were pedicled and 18 were free flaps. A total of 10 flaps were osteomyocutaneous and 19 were myocutaneous. The mean vertical size of the harvested skin paddle was 30.72 ± 4.57 cm (range: 20-38), and the mean horizontal size of the skin paddle was 8.69 ± 0.80 (range: 7-10) cm, with the mean maximum horizontal extensions of the flaps being 16.03 ± 1.18 (range: 14-18) cm. The flap survival rates were 100%. One flap had distal partial loss (less than 5%). Donor site complications included seroma (1) and numbness (1), both of which were managed conservatively. The average follow-up time was 23.97 ± 7.19 months. Conclusion The presented modified extended fleur-de-lis LD myocutaneous/osteomyocutaneous flap for reconstruction of multi-directional complex soft tissue and bone defects is a good and reliable option, with low donor site morbidity.