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American Association for Hand Surgery

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Shoulder Donor Site Morbidity is Significantly Different Following Full and Thoracodorsal Nerve Preserving Split Latissimus Dorsi Flaps
Harvey Chim, MD1, Haley Oberhofer, BSc2, Sonja Samant, BS2, Ellen S Satteson, MD3 and Mark Leyngold, MD4, (1)Division of Plastic Surgery, University of Florida College of Medicine, Gainesville, FL, (2)University of Florida, Gainesville, FL, (3)University of Florida, Gainesville, CA, (4)University of Florida, GAINESVILLE, FL

Introduction
The latissimus dorsi (LD) flap is a workhorse for reconstruction. However, flap harvest has been variably reported to result in donor site morbidity. The aim of this study was to compare donor site morbidity following harvest of a split LD flap, preserving the anterior branch of the thoracodorsal nerve, and a traditional nerve sacrificing full LD flap.
Materials and Methods
Patients who underwent split or full latissimus dorsi flaps between July 2017 and August 2020 at a single center were recalled for assessment. Donor site morbidity in the shoulder was evaluated through the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Shoulder Pain and Disability Index (SPADI), and American Shoulder and Elbow Surgeons (ASES) questionnaires. Medical Research Council (MRC) strength grading was also performed.
Results
A total of 22 patients were recalled in the split LD cohort and 22 patients in the full LD cohort. Patient reported outcomes as assessed through DASH, SPADI and ASES scores revealed statistically greater (p<0.05) donor site morbidity associated with the traditional compared to split LD flap. Seven patients in the full LD cohort had less than MRC grade 5 power at the shoulder while all patients in the split LD cohort demonstrated full power at the shoulder.
Conclusions
Traditional full LD flaps were found to result in greater donor site morbidity compared to thoracodorsal nerve preserving split LD flaps. Split LD flaps may be beneficial in preserving donor site function and strength.


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