Dynamic Reconstruction Using Accessory-innervated Pedicled Latissimus Dorsi Flap for Upper Trapezius Muscle Defect

Summary:

The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial movement. We encountered a case in which the upper trapezius muscle was completely resected due to myxofibrosarcoma that occurred in the upper part of the left trapezius muscle, and reconstruction was performed using a pedicled latissimus dorsi flap with the accessory nerve transferred, resulting in favorable motor function. A 74-year-old woman developed myxofibrosarcoma in her left neck 1 year and 4 months ago, and underwent two surgical excisions at a nearby hospital. However, two months prior, she relapsed again, and was referred to our hospital, where she underwent submandibular lymph node dissection, wide tumor resection, and reconstruction using a latissimus dorsi flap. For latissimus dorsi myocutaneous flap transfer, the stump of the thoracodorsal nerve and accessory nerve were anastomosed to facilitate nerve transfer. Four months after surgery, she was able to raise her shoulder, and surface electromyography showed potentials comparable to her unaffected side. The innervated latissimus dorsi myocutaneous flap is frequently used for dynamic reconstruction of facial, brachialis, rectus abdominis, and deltoid muscles, but this is the first case report describing its use for dynamic reconstruction of the trapezius muscle.