Pedicled Latissimus Dorsi Flap Vascularized by a Lumbar Artery Perforator for the Reconstruction of an Exposed Lumbar Spinal Fixation Device: A Case Report

TL;DR

A 74-year-old woman with a spinal ulcer was successfully treated using a latissimus dorsi flap vascularized by a lumbar artery, confirmed with ICG angiography.

Contribution

This case report introduces the rare use of lumbar artery perforators for latissimus dorsi flap reconstruction in spinal device exposure.

Findings

A pedicled latissimus dorsi flap vascularized by lumbar artery perforators successfully reconstructed an exposed spinal device.

ICG fluorescence angiography confirmed flap perfusion and was effective for preoperative evaluation.

No ulcer recurrence was observed after six months of follow-up.

Abstract

Latissimus dorsi flaps are typically vascularized by the thoracodorsal or intercostal artery perforators, while cases describing the use of lumbar artery perforators are exceedingly rare. This report presents a case of a 74-year-old woman presenting with a refractory ulcer associated with an exposed lumbar spinal fixation device. Reconstruction was successfully performed using a pedicled latissimus dorsi flap vascularized by lumbar artery perforators. Preoperative indocyanine green (ICG) fluorescence angiography confirmed adequate perfusion from the lumbar artery perforators. Postoperative outcomes were favorable, with no ulcer recurrence observed after six months of follow-up. Chronic inflammation and malignancy were considered as likely contributors to angiogenesis and increased blood flow around the lumbar artery perforators. Additionally, ICG fluorescence angiography proved an effective and minimally invasive technique for evaluating flap perfusion.

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