Case 14: Pushing Beyond Anatomical Boundaries: Latissimus Dorsi Sliding Flap for Lower Thoracic Wall Reconstruction

Keywords: Latissimus dorsi flap, sliding flap, thoracic wall reconstruction Authors: Sophie Osenegg, MD, Oliver Didzun, MD, Amir K. Bigdeli, MD, Chief. Institution: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Klinikum Kassel, Teaching Hospital of Philipps University Marburg, Kassel, Germany Abstract A 78-year-old multimorbid patient with chronic osteomyelitis and a full-thickness soft tissue defect (12 × 6 × 5 cm) of the right flank required flap reconstruction following multiple debridements. Given the absence of nearby recipient vessels and perforators, an ipsilateral myocutaneous latissimus dorsi sliding flap was selected. The thoracodorsal pedicle was extended by 30 cm using autologous venous grafts to achieve cranial reach while preserving anterograde arterial flow. This case illustrates the rarely described use of a latissimus dorsi sliding flap in complex reconstructions, emphasizing vascular adaptation techniques. Patient medical history A 78-year-old male had undergone right-sided nephrectomy in 1970 for renal cell carcinoma. Following initially uneventful wound healing, a chronic wound developed at the nephrectomy site, which the patient managed conservatively over the subsequent decades. In September 2024, he presented with spontaneous purulent discharge from the right flank, attributable to chronic osteomyelitis of the adjacent ribs. In addition, intraperitoneal infection with Staphylococcus aureus was confirmed. Serial debridements were performed by the departments of general and thoracic surgery, including partial rib resections and an atypical laparotomy. These interventions resulted in a full-thickness soft tissue defect of the right flank, measuring 12 × 6 × 5 cm, with exposed ribs and peritoneum. The patient was subsequently referred to our department for reconstructive management under ongoing open wound therapy. At the time of presentation, his medical history included stage V chronic kidney disease with initiation of hemod