Pedicled Latissimus Dorsi Flap for Extensive Scalp Reconstruction in Acute Burns

Extensive full-thickness head and neck burn defects represent some of the greatest challenges because of the exposure of burned calvaria and lack of good local reconstructive options. This study reports the use of a pedicled latissimus dorsi (LD) muscle flap to cover a large full-thickness scalp burn defect measuring 20 x 15 cm, including 15 x 13.7 cm of bone exposure and extending from the posterior neck to the mastoid and vertex of the scalp. The authors discuss the technique to safely maximize the reach, which includes distal dissection to the iliac crest and thoracolumbar fascia, dissection of the pedicle to the axillary vessels, tunnel creation through the pectoralis major muscle, re-attachment of the LD origin to the pectoralis major and teres major, and undermining of the neck skin and subcutaneous tissue to avoid damage of the accessory nerve. This case highlights the reach of a pedicled LD muscle flap for extensive scalp reconstruction for defects all the way to the vertex and beyond. The size and reliability of the LD muscle makes it a valuable alternative for large scalp defects for cases of complex scalp reconstruction in patients deemed not ideal candidates for free flap reconstruction.