Causes of failure in the use of a pedicled latissimus dorsi musculocutaneous flap in delayed reconstruction of a scalp and facial defect: a case report

Abstract

Background: To prevent failure of a pedicled latissimus dorsi musculocutaneous axial flap in high facial reconstruction, it is advisable that the blood flow and extent of reach of the thoracodorsal vessel must be ascertained during preoperative assessment using Laser Doppler perfusion imaging. The aim of this report was to document possible causes of failure and necessary precautions that will enhance the take of this flap in the repair of scalp and high level facial defects. Methods: A 19-year-old female patient was brought into the casualty department of our hospital with a history of extensive injury to the left side of the scalp and face due to a road traffic accident. A delayed reconstruction of the defect using a pedicled latissimus dorsi musculocutaneous flap was performed two weeks following admission. Results: On the sixth post-operative day, a blister appeared on the flap and the color of the flap skin had turned black, there was a persistent purulent discharge, her vital signs had deteriorated by the 8th postoperative day, fever and vomiting had persisted. Conclusion: Although latissimus dorsi island or axial musculocutaneous flap offers sufficient tissue of compatible skin color and thickness, it may be necessary to avoid tunneling of the axial flap and ensure that adequate assessment and precautions are done before embarking on this time consuming reconstructive surgery.

Keywords: flap failure, latissimus dorsi flap, scalp and facial trauma