Pedicled Latissimus Dorsi Flap for Head and Neck Defects in the Age of Microvascular Reconstruction.

Abstract

Background: Pedicled latissimus dorsi flap (LDF) based on the thoracodorsal artery provides large vascularized skin paddle along with underlying muscle. This study describes the relevance and feasibility of undertaking reconstruction of complex head and neck defects with pedicled LDF with emphasis on salvage situations and non-availability of pectoralis major flap.

Methods: Retrospective cohort study on all consecutive cases of LDF reconstruction performed from July 2022 to June 2025. Modifications to the traditional LDF harvest introduced were: transaxillary tunnel creation in the supine, arm-abducted position and subpectoral tunnelling was avoided by careful division of the pectoralis major humeral fibres.

Results: 16 patients underwent LDF reconstruction for head and neck defects during the study period. The indications for selecting the LDF for reconstruction were: recurrent head and neck cancer with vessel-depleted neck and prior use of pectoralis major (n = 5), salvage following necrosis of pectoralis major flap (n = 4) and primary form of reconstruction in female patients (n = 8). The head and neck sites reconstructed were: gingivobuccal complex (n = 11), tongue (n = 4) and temporal bone (n = 1). Flap survival rate was documented at 87.5%. Donor site seroma developed in 2 patients and minor would complication in the form of suture dehiscence was encountered in 1 patient. None of the patients developed restriction of shoulder mobility.

Conclusion:  Pedicled LDF is a promising fallback option following salvage surgeries and in the non-availability of pectoralis major flap.