Case 24 2026: Ipsilateral Myocutaneous Latissimus Dorsi Flap for Traumatic Upper Limb Soft Tissue and Vascular Injury Following Road Traffic Accident
Sumaira Sattar1
- 1SMBB Institute of Trauma, Karachi, Pakistan
Abstract
Keywords: Latissimus dorsi flap, upper limb trauma, soft tissue reconstruction, vascular injury, degloving injury Authors: Sumaira Sattar, FCPS (Plastic Surgery), Institution: SMBB Institute of Trauma, Karachi, Pakistan Abstract A 20-year-old female presented with a severe traumatic injury to the right upper limb following a road traffic accident involving a pedestrian–motorbike collision with subsequent run-over injury. The trauma resulted in extensive soft tissue loss, degloving injury, and associated vascular compromise. Initial management followed advanced trauma protocols, after which the patient was referred for vascular and reconstructive assessment. Imaging revealed brachial artery thrombosis with segmental radial artery injury; however, hand perfusion was maintained through collateral circulation. Following stabilization and vascular reconstruction using a reverse great saphenous vein graft, soft tissue coverage was achieved with an ipsilateral myocutaneous latissimus dorsi flapThe flap provided durable coverage of exposed vital structures and the elbow joint without the need for microsurgical anastomosis. At three-month follow-up, the patient demonstrated excellent functional recovery with satisfactory aesthetic outcome. This case highlights the reliability of the latissimus dorsi flap in complex traumatic upper limb reconstruction. Patient medical history A 20-year-old unmarried female, with no known comorbidities, presented to the emergency department five hours after a road traffic accident involving a bike-versus-pedestrian collision. Following the initial fall, the patient sustained a secondary run-over injury to the right upper limb. There was no history of loss of consciousness, head injury, or trauma to other body regions. Initial assessment and stabilization were performed according to trauma protocols, following which the patient was referred to the plastic and vascular surgery teams for definitive management of the limb injury. Before and After
BeforeAfterA 20-year-old unmarried female, with no known comorbidities, presented to the emergency department five hours after a road traffic accident involving a bike-versus-pedestrian collision. Following the initial fall, the patient sustained a secondary run-over injury to the right upper limb. There was no history of loss of consciousness, head injury, or trauma to other body regions. Initial assessment and stabilization were performed according to trauma protocols, following which the patient was referred to the plastic and vascular surgery teams for definitive management of the limb injury.
Under general anesthesia, thorough surgical debridement of devitalized tissue was performed
The vascular surgery team reconstructed the brachial artery using an approximately 8-cm reverse great saphenous vein graft, restoring arterial continuity. Exploration of the median and ulnar nerves revealed them to be intact.
2
A myocutaneous latissimus dorsi flap measuring approximately 19 × 9 cm was designed on the ipsilateral side. Distally, the skin paddle was extended till 4 cmabove the posterior superior iliac crest to maximize coverage.
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The flap was elevated in a standard fashion
4
dissection carried out up to the thoracodorsal pedicle to increase the arc of rotation.
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The flap was tunneled through the axillary region and inset to cover the exposed neurovascular structures and elbow joint. Surrounding areas were resurfaced with split-thickness skin grafts
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The postoperative course was largely uneventful. A minor complication in the form of partial skin graft loss was observed, which was managed conservatively with wound cultures, targeted antibiotic therapy, and regular dressings. The affected area was subsequently regrafted with satisfactory take.
Follow-Up
At three months postoperatively, the patient remained under regular follow-up. The flap was healthy with stable coverage, and there was no evidence of infection or breakdown. The patient achieved excellent functional recovery of the limb with a good aesthetic outcome and minimal donor-site morbidity.
How to cite this article
Sumaira Sattar. Case 24 2026: Ipsilateral Myocutaneous Latissimus Dorsi Flap for Traumatic Upper Limb Soft Tissue and Vascular Injury Following Road Traffic Accident. Journal of Plastic, Breast & Reconstructive Surgery. 2026.
Open access. © 2026 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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