Versatile use of the pedicled latissimus dorsi flap as a salvage procedure in reconstruction of complex injuries of the upper extremity

Complex injuries of the upper limb are usually associated with massive soft tissue necrosis, infection, and exposure of the vital structures. Management is fairly problematic, requiring multiple operations and prolonged hospitalization. We herein present a versatile use of the pedicled latissimus dorsi flap as a salvage procedure, and its advantages. In 6 patients with such injuries, all known variations of the flap have been successfully used as a musculocutaneous, pure muscle, and pure skin (thoracodorsal artery perforator) flap. The mean follow-up time was 11.8 months. All flaps survived completely. The donor sites were closed primarily, with acceptable linear scars in all cases. Variants of the pedicled latissimus dorsi flap may be suitable to address complex defects of the upper extremity, including forearm and hand, which have little chance for free flap. Content of the flap to be used should be determined depending on requirements in the recipient site.