Functional and Aesthetic Reconstruction of Shoulder Using Pedicled LD Flap after Radical Debridement of Tuberculosis Infected Rheumatoid Arthritis Wound

Reconstruction of large shoulder defects is challenging, especially in complicated chronic wounds. We report a case of a tuberculosis-infected shoulder defect in a patient with rheumatoid arthritis (RA) that was successfully reconstructed with pedicled latissimus dorsi (LD) musculocutaneous flap coverage. A 57-year-old male visited our department with a severely painful open wound (0.5 cm×0.5 cm), later confirmed to be tuberculosis (TB) infected, in the right anterior shoulder region. Several surgical interventions including open synovectomy had been performed at a local orthopedic clinic before the patient presented at our institute. We performed radical debridement and successfully reconstructed the defect with a combination of TB medication, corticosteriod tapering, complete removal of non-viable tissue, and a pedicled LD flap to provide adequate skin and soft tissue volume. Chronic shoulder wounds should be carefully examined for TB infections, which, although extremely rare, can lead to joint destruction and` extensive soft tissue defects when diagnosis is delayed. In terms of flap choice, the pedicled LD musculocutaneous flap has many advantages for functional and aesthetic reconstruction of a large defect in the shoulder region.