Repair of Non-Circumferential Cervical Trachea Defects by Three Different Latissimus Dorsi Flaps

Aim and background A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. Methods The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. Results After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. Conclusions There is no balance between price list and effective cost of the different surgical reconstructive procedures, which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regions and hospitals to improve the service, keeping it at a good level.

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Primary closure of large thoracolumbar myelomeningocele with bilateral latissimus dorsi flaps

Journal of Neurosurgery Pediatrics ◽

10.3171/2008.12.peds08226 ◽

2009 ◽

Vol 3 (4) ◽

pp. 331-333 ◽

Cited By ~ 7

Author(s):

Mehrdad Hosseinpour ◽

Siamak Forghani

Keyword(s):

Wound Healing ◽

Latissimus Dorsi ◽

Major Complication ◽

Posterior Axillary Line ◽

Skin Island ◽

The Mean ◽

Free Closure ◽

Human Birth ◽

Pedicle Flaps ◽

Latissimus Dorsi Flaps

Object Myelomeningocele (MMC) is the most complex congenital malformation of the CNS that is compatible with life. Different closure techniques are available for defect reconstruction, but wound healing and tension-free closure of the skin in the midline remain major considerations in large MMCs. In this study, the authors used bilateral proximally based latissimus dorsi (LD) skin island muscle pedicle flaps for closure of large thoracolumbar MMC defects. Methods Twenty infants with very large thoracolumbar MMCs were enrolled in the study. The mean of age of the patients was 4.1 ± 2.3 months. The width of the MMC was 6 ± 1.2 cm. At operation, 2 triangular V-Y flaps were designed on each side of the defect; the tip of the triangle was extended to the posterior axillary line. The LD flaps based on the thoracodorsal arteries were elevated bilaterally and advanced toward the midline with moderate tension and sutured together. Postoperatively, infants were positioned prone for 7 days and discharged on the 8th day after the operation. They were followed every 2 weeks for evaluation of wound healing. Results The wounds healed without any major complication. There was no dehiscence in the postoperative period. Conclusions The authors recommended bilateral superiorly based LD skin flaps as an effective method for closure of large thoracolumbar MMC defects. Neural tube defects are among the most common of all human birth defects.

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