1, right). Patient data are summarized in Table 1. All skin defects could be covered by the flaps and all

wounds of donor site could be closed without skin grafts. Postoperatively, all flaps survived completely, and no wound complications occurred in any patient. The mean follow-up period was 11.5 months (range, 4 to 22 months). The functional and aesthetic results were satisfactory in all patients. A 44-year-old woman presented with a malignant fibrous histiocytoma of the right scapular region. Wide resection of the tumor resulted in a 13.5 × 12-cm2 skin defect, and the medial edge of the scapula was exposed (Fig. 2A). To reconstruct find more this defect, a latissimus dorsi musculocutaneous flap with an 18 × 7-cm2 skin island was harvested from the right side. The skin island was designed so that its longitudinal axis was perpendicular to the line of least

skin tension of the recipient site (Fig. 2B). The recipient defect was partially closed primarily at both ends, and the flap was transferred to the remaining defect through a subcutaneous tunnel. The donor site was closed primarily (Fig. 2C). The postoperative course was uneventful. Four months after the operation, the cosmetic outcome was satisfactory with minimal contour deformity, and no functional disturbance was observed (Fig. 2D). Closing large skin defects of the upper back is a challenging problem. The high tension on the wound edges resulting from primary closure might lead to dehiscence or tension necrosis. However, the tautness of the surrounding skin precludes the use of local flaps. Because the scapula or vertebrae learn more are often exposed, skin grafts directly to the defect are not indicated. Furthermore, if dead space is not adequately obliterated, wound healing can be delayed because of the mobility of the scapula. Transfer of a pedicled latissimus

dorsi musculocutaneous flap is the method of choice for reconstructing the skin of the upper back.[2] Advantages include a large, consistent, STK38 and reliable vascular pedicle; a highly flexible skin island design; ease of flap elevation; and minimal donor-site morbidity.[6] The only problem with this flap is that closure of the donor site interferes with closure of the recipient site, which can become enlarged, depending on the orientation of the skin island. Our flap design is novel because closure of the flap donor site changes the shape of the recipient site to one that is easier to close. The longitudinal axis of the skin island is perpendicular to the line of least skin tension of the recipient site, and primary closure of the flap donor site changes the shape of recipient site from circular to elliptical. This change in shape allows partial primary closure of the recipient site and reduces the required width of the skin island. The elliptical skin defect can be closed with the skin island of the flap without undue tension.