No wound complications occurred in any patient. Functional and aesthetic outcomes were satisfactory in all patients. This flap design is effective for reconstructing large skin defects of the upper back. © 2013 Wiley Periodicals, Inc. Microsurgery 34:20–22, 2014. Closing large skin defects of the upper back is a challenging problem.[1] Transfer of a pedicled latissimus dorsi musculocutaneous flap is the method of choice for reconstruction in this region[2]; however, primary closure of the donor site can interfere with closure Epacadostat in vitro of the recipient site, which can become enlarged depending on the

orientation of the skin island. A simple solution is combined use of a skin graft; however, wound healing problems and significant contour deformities can develop.[3, 4] To reconstruct large skin defects of the upper back, we have developed an efficient design for a latissimus dorsi musculocutaneous flap that does not require skin grafts. We describe our surgical technique and report the outcomes of four cases. From March 2011 to September 2012,

we used pedicled latissimus dorsi musculocutaneous flaps to repair large skin defects of the upper back immediately after wide excision of malignant tumors in four consecutive patients, and Z-VAD-FMK purchase these patients were included in this study. Defects with a minor diameter greater than 10 cm were defined as large defects. Two patients were men and two were women, and their mean age was 51.5 years. Our design concept was based on the principle that the shape of the skin defect being reconstructed is changed when primary closure of the adjacent flap donor site is attempted.[5] We took advantage of this principle and developed a flap with a donor site whose primary closure changes the shape of the skin defect being reconstructed from circular to elliptical and, therefore, makes it easier to reconstruct. The operative procedure was usually performed with the patient Thiamine-diphosphate kinase in either the lateral or the prone position. After tumor ablation, the line of least skin

tension at the defect was determined with a pinch test. The ipsilateral latissimus dorsi musculocutaneous flap was designed so that the longitudinal axis of its skin island was perpendicular to this line (Fig. 1, left). We pinched the flap donor site to simulate primary closure and confirmed that the shape of the recipient site will change from circular to elliptical (Fig. 1, center). Then, the defect was partially closed at either end or both ends, and the required flap size was determined by reference to the remaining defect. Finally, an elliptical skin island was designed on the latissimus dorsi muscle along the axis mentioned above. The flap was raised in the regular manner and transferred to the defect through a subcutaneous tunnel. The amount of the latissimus dorsi muscle included in the flap depended on the dead space of the defect.