40 years of microvascular reconstruction with latissimus dorsi muscle free flap

Abstract

Introduction: The first use of the latissimus dorsi as a myocutaneous flap was described as early as the end of the 19th century, in the coverage of an extensive defect following radical mastectomy (Tansini 1895). Subsequently, the surgical procedure was forgotten and later re-introduced as a pedicled flap for breast reconstruction (Olivari 1976). Olivari prompted the microsurgical team from Ljubljana to perform a free muscle transfer (Godina 1978). The first emergency free flap transfer in Ljubljana was performed in 1979.Patients and Methods: Latissimus dorsi flap can be used as a muscle or musculocutaneous flap, in a pedicle or a free form. The procedure of reconstructing large tibial defects always proceeded as a two-team procedure simultaneously. For the continuity of the axial blood flow of the tibia, M. Godina developed end-to-side anastomosis.Results: Using latissimus dorsi free flap for reconstruction of tibial defects the first statistics by M. Godina from 134 patients showed a 0.75% flap loss rate and 1.5% infection rate; an average healing time of 6.8 months and a bed rest period estimated at 27 days. In the case of delayed reconstruction, the author reported an infection rate of 17.5%.Conclusions: Due to clinical experience, good results and a new doctrine of the Ljubljana School of microsurgery played a historical role in the reconstruction of the tibia with a muscular microvascular muscle flap.