[The Free Functional Latissimus dorsi Flap for the Reconstruction of Complex Abdominal Wall Defects: Anatomy, Technique and Approach for Interdisciplinary Treatment].

Abstract

Complex abdominal wall defects lead to significant morbidity and require interdisciplinary therapeutic approaches. Plastic surgical techniques and the evolvement of microsurgery can provide a reliable means of reconstruction. For large defects involving the M. rectus abdominis, the free functional M. latissimus dorsi flap serves as a workhorse. Through microsurgical tissue transplantation, the abdominal wall can be functionally reinforced and reinnervated, while also covering the associated soft tissue defect.This study presents an interdisciplinary approach to complex abdominal wall reconstruction using a case example.Particularly as a chimeric flap, in combination with the scapular/parascapular flap, even exceptionally large defects can be reconstructed safely. By utilising a common vascular pedicle, these flaps can be transferred together via the subscapular vessel axis. The coaptation of the thoracodorsal nerve, which innervates the latissimus dorsi muscle, with a motor nerve branch leading to the rectus abdominis muscle enables functional muscular stabilisation of the abdominal wall following reinnervation.To achieve the best possible outcome and reduce hospitalisation, the early integration of plastic surgery into interdisciplinary treatment concept is essential.