Latissimus Free Flaps for Massive Brain and Craniofacial Skull Wounds
Large defects of the craniofacial skull that are created from cancers, trauma, radiation, or other causes, often require microvascular free tissue transfer to close the wounds. On the vertex of the skull, there is limited tissue to close even small wounds and the amount of tissue is often decreased even more significantly if the tissue mobility is affected by radiation. The transfer of free muscle allows the operative surgeon to 1) cover any open wounds and 2) obliterate dead space which can often cause recurrent or recalcitrant infections.
Massive wounds of the brain and skull require complete debridement of all devitalized, radiated, necrotic, and osteomyelitic bone to allow the wound to heal properly. After all of the necrotic and devitalized material has been debrided, then the microsurgeon can bring well vascularized tissue to the area to help heal the wound.
The latissimus dorsi offers the most optimal muscle to be transferred to the scalp as it has a broad surface area to cover the entire scalp. The size match of the thoracodorsal vessels also coincide well with the size match of the superfical temporal artery and vein to allow an appropriate size match. It is important for the operative surgeon to be prepared to harvest either the greater saphenous vein or the lesser saphenous vein in the lower extremity in case the superficial temporal vein is inadequate. In this case the venous anastamosis needs to be jumped to the external jugular vein in the neck. This should be marked out pre-operatively and no central venous lines placed on that side of the neck pre-operatively.
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