Donor site morbidity: standard versus partial latissimus dorsi free flap

Abstract 

Over the last 7 years 128 latissimus dorsi free flaps have been performed at the BG Unfallklinik in Murnau. Since 1995, the use of a partial latissimus dorsi, sized according to the defect that has to be covered, leaving a functional remnant has continuously increased. We compared the donor site morbidity after standard and after partial latissimus dorsi flap in a small group of 10 patients each (n=20). The mean follow-up time was 18 and 24 months, the mean age of the patient 42.5 and 43.6 years. The evaluation included complaints, subjective loss of strength, scar length, ROM of the shoulder, and measured loss of strength, taking into account the patient’s dominant side. The acceptance of the donor area by the patients was very good in both groups. It was found that the loss of strength after partial latissimus dorsi is less evident than after standard latissimus dorsi. The scar length was independent of the type of flap chosen. There was no loss in range of movement. In both groups it was found that if the flap was taken from the non-dominant side the difference in strength to the dominant side was more than if the flap was taken from the dominant side. We could not see a causal relationship between age and the amount of strength lost. Because of the decreased donor site morbidity we think the partial latissimus dorsi flap should be used instead of the standard latissimus whenever possible.