Microsurgical Reconstruction of a Cranial Defect Using a Latissimus Dorsi Flap: A Case Report

The reconstruction of complex cranial defects, particularly in the temporal region, poses a significant surgical challenge due to both functional and aesthetic considerations, as well as the anatomical constraints of the area. We present the case of a 64-year-old female patient with an extensive cranial defect in the temporal region, secondary to a previous surgical resection. Owing to the complexity of the defect and the presence of bone exposure, a microsurgical reconstruction using a free latissimus dorsi (LD) flap was undertaken. The procedure involved harvesting the flap in the lateral decubitus position, ensuring a long, well-calibered vascular pedicle, followed by free tissue transfer and microvascular anastomosis to the superficial temporal vessels. The LD flap was chosen for its volume, versatility, and reliable vascular supply, which enabled effective coverage and restoration of the cranial contour. This case highlights the LD flap as a safe and effective option for reconstructing complex cranial defects in the temporal region. Key factors in the success of the procedure included thorough preoperative planning, microsurgical expertise, and a multidisciplinary approach. Emphasis is placed on tailoring the reconstructive strategy to the defect's size, location, and characteristics, as well as the patient's overall condition. Ultimately, the reconstruction of complex cranial defects requires an individualized surgical approach. The free LD flap offers a versatile and dependable solution, thanks to its large surface area, robust vascularity, and ability to adapt to 3D contours. Microsurgical techniques allow for precise vascular anastomosis, promoting flap integration and reducing the risk of complications. This case demonstrates that with careful planning and execution, excellent functional and aesthetic outcomes can be achieved.