Split Latissimus Dorsi Muscle Flap Wrapping of a Graft for Infectious Aneurysm of the Proximal Descending Thoracic Aorta

In cases of infectious thoracic aortic aneurysm in which the omentum is unavailable, the aortic graft can be wrapped with a latissimus dorsi muscle (LDM) flap. However, it is difficult to use a simple LDM flap to wrap the proximal descending thoracic aorta owing to its curved and linear form. Here we describe a case in which splitting the LDM flap into two separate hemiflaps with two vascular branches achieved full-circumference wrapping closure with the curved portion enveloped by the horizontal hemiflap and the straight portion enveloped by the vertical hemiflap. The infection was well controlled, and no anastomotic failure occurred during 18 months of follow-up. Our findings suggest that split LDM flaps may be a good alternative for covering the proximal descending thoracic aorta when the omentum is unavailable.