The Pedicled Descending Branch Muscle-Sparing Latissimus Dorsi Flap for Breast Reconstruction

Background: The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely oriented skin paddle presents distinct advantages in breast reconstruction, including reduced donor-site morbidity and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, complications, and aesthetic and functional outcomes following use of this flap for breast reconstruction. Methods: A retrospective study of 20 patients who underwent breast reconstruction with a pedicled muscle-sparing latissimus dorsi musculocutaneous flap was conducted. Indications for surgery included breast reconstruction following mastectomy, lumpectomy, and irradiation, and for correction of implant-related complications. Case-note review was performed, as was a functional evaluation consisting of a patient questionnaire, a Disabilities of the Arm, Shoulder, and Hand form, postoperative range-of-motion analysis, and instrumented strength testing comparing the operated and nonoperated sides. Aesthetic evaluation of the donor site was conducted by all patients. An anatomical study of 15 flaps harvested from fresh cadavers was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch. Results: Twenty-four descending branch muscle-sparing latissimus dorsi flaps were harvested. All donor sites were closed primarily, with skin paddle sizes ranging up to 25 X 12 cm. There was one case of minor flap tip necrosis and no instances of seroma. There was no statistically significant difference in strength or range of motion of the shoulder joint when comparing the operated to the nonoperated side. Two patients reported minor functional impact following surgery. Conclusions: The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar. (Plast. Reconstr. Surg. 123: 13, 2009.)