Latissimus Dorsi Flap

Abstract

The latissimus dorsi (LD) flap is a Mathes–Nahai type V flap (one major pedicle, multiple minor pedicles) and is the widest muscle in the human body. It is a workhorse flap in the armamentarium of the plastic surgeon. It is commonly used to reconstruct multiple, wide, or long lower extremity defects. Also, the ability to tuck the muscle deep into the wound allows for effective filling of unusual wound dimensions. The muscle serves as an external rotator and adductor of the humerus, and its sacrifice does not result in a significant defect for the patient. In addition, it has a very reliable blood supply, with a pedicle that is long (up to 15 cm) and wide (up to 5 mm if taken at the subscapular), making it an easy microsurgery target. The muscle is also quite thin, making it easy to be draped around difficult surfaces. It can be harvested as an innervated flap based on the thoracodorsal nerve. Finally, it can be harvested as a chimeric flap, with the addition of serratus anterior muscle, fasciocutaneous component (scapular/parascapular), or osseous segments (tip of the scapula or lateral border of the scapula).