The pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction

Background: 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 latissimus dorsi myocutaneous flap in reconstructing defects on the trunk and upper extremities. Methods: Five patients with defects on the trunk or upper extremities had soft tissue reconstruction with a pedicled descending branch muscle-sparing latissimus dorsi myocutaneous flap. A transverse skin paddle design was used in all cases. All flaps were performed by the senior author. Complications were recorded, and range of motion analysis was performed comparing operated and non-operated sides during follow-up appointments. Results: The descending branch muscle-sparing latissimus dorsi flap was used for reconstruction of: the chest wall (2), axilla (2) and upper extremity (1). The skin paddles harvested ranged from 15 x 7 cm to 24 x 9 cm. All donor sites were closed primarily. There was one case of minor wound dehiscence on the donor site and one case of wound infection (reconstruction was for chronic, severe axillary hidradenitis suppuritiva). There were no incidences of seroma. In all cases, there was no difference in strength or range of motion around the shoulder joint when comparing the operated to the non-operated side. Conclusion: The pedicled descending branch muscle-sparing latissimus dorsi myocutaneous flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, low rate of flap complications and an aesthetically acceptable scar. (C) 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.