Pedicled Latissimus Dorsi Flap for Malignant Defects: A Reliable Alternative to Free Flap Reconstruction

Introduction: Wide upper extremity soft tissue defects with exposed bone following malignant tumor excision remain a significant reconstructive challenge. Although free flaps are the gold standard for large coverage, factors such as advanced age, comorbidities, or limited microvascular resources may require alternative approaches. In such settings, the pedicled latissimus dorsi flap provides a reliable and effective reconstructive solution. Case Illustration: A 70-year-old man presented with a 15 × 12 cm soft tissue defect in the right upper arm extremity following malignant tumor excision, with exposed humerus and complete loss of the deltoid muscle. Reconstruction was performed using a pedicled latissimus dorsi flap to cover the exposed bone, combined with split-thickness skin grafts harvested from the lateral right thigh for residual defects (3 × 3 cm and 5 × 2 cm). The flap remained viable, surgical drains were placed, and the extremity was immobilized with a cast to support healing. Discussion: The pedicled latissimus dorsi flap provided reliable vascularized coverage for the exposed humerus and compensated for deltoid loss, avoiding the longer operative time and microsurgical demands of free flaps. In this elderly patient, the flap healed successfully with full graft take and complete donor-site epithelialization, demonstrating its safety and effectiveness. These outcomes support the continued use of pedicled LD flaps as a practical alternative for large upper-extremity oncologic defects, especially when patient comorbidities or treatment factors limit free flap reconstruction. Conclusions: The pedicled latissimus dorsi flap remains a safe and effective option for wide malignant defects of the upper extremity, serving not just as a substitute for free flaps but as a strategic choice that balances surgical safety, functional restoration, and patient-centered outcomes.