The Free Descending Branch Muscle-Sparing Latissimus Dorsi Flap

ArticleinPlastic and Reconstructive Surgery 130(6):776e-87e · December 2012with51 Reads
DOI: 10.1097/PRS.0b013e31826d9c5e · Source: PubMed
: Increasing focus on reducing morbidity from latissimus dorsi flaps has led to the evolution of muscle-sparing variants and perforator-based flaps. This study aimed to investigate the vascular anatomy of the muscle-sparing variant and to describe its application as a free flap based on the descending branch of the thoracodorsal artery. : Twelve fresh cadavers underwent anatomical dissection and angiographic injection studies of the thoracodorsal arterial system. The musculocutaneous territories of the descending and transverse branches to the latissimus dorsi muscle were identified and assessed using three-dimensional reconstruction software of computed tomography imaging results. In the clinical study, five patients underwent reconstruction of a variety of defects using the free descending branch muscle-sparing latissimus dorsi flap. : Three- and four-dimensional (computed tomography) angiography demonstrated perfusion of the latissimus dorsi muscle by the transverse and descending branches, with overlap of vascular territories via cross-linking vessels. The descending branch supplied a slightly greater cutaneous area overlying the muscle, although differences between both branches were not significant (p = 0.76). In the clinical study, the free muscle-sparing latissimus dorsi flap provided excellent coverage with no flap complications or seroma. : The free muscle-sparing latissimus dorsi flap based on the descending branch of the thoracodorsal artery is a viable reconstructive option. Significant collateral flow between vessels allows for larger flap harvest than would be expected. The flap is technically simple to harvest, provides a large perfusion area, and is a reliable variant of the full latissimus dorsi flap. : Therapeutic, V.

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    The major blood supply of the latissimus dorsi muscle flap is based on the descending and tranverse branches of the thoracodorsal artery. This segmental blood supply allows the muscle to be split and harvested based solely on vascularization from the descending branch, thus sparing the latissimus dorsi muscle function. This article reports the use of the descending branch muscle-sparing... [Show full abstract]
      The latissimus dorsi flap has traditionally been the workhorse flap for the reconstructive surgeon. Over the years modifications and refinements increased its versatility and frequently this flap is used in a variety of reconstructive procedures. Understanding the vascular anatomy of the thoracodorsal artery has lead to variations in the orientations of the skin paddle. Traditionally, the skin... [Show full abstract]
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