Authors: Caroline Lilja, MD., Emma Tubæk Nielsen, stud.med., Magnus Balslev Avnstorp, MD., and Stephan Thunich, MD.

Pearls

• The flap can be combined with other subscapular flaps.
• On average, the pedicle is 7-12 cm long.
• The average diameter of the thoracodorsal artery is 1.5-4 mm.
• Along the anterolateral border of the muscle is where the highest density of perforators is located, making it ideal for harvest.
• If a smaller skin island is desired, harvesting surrounding subcutaneous tissue allows for additional perforators, and increases the chances of flap survival.
• Seroma formation can be reduced by utilizing drains, in addition of fixation of the skin with tacking sutures.
• Donor scarring can be reduced with an endoscopic-assessed harvest.
• Initially, the flap might be bulky in the site of reconstruction, but because of its denervation it will atrophy over time.
• The biggest dimensions of the latissimus dorsi muscle is 20×40 cm.
• The size of the skin paddle harvested, should not exceed 10 cm in width, in order to close the wound directly. ¹

Pit-falls

• Because the perforators are usually not identified prior to or during the surgery, there is a risk of compromised blood supply if the skin island is of a smaller size. 
• Whilst dissecting the neurovascular pedicle of the flap, care should be taken in to preserve the innervation of the remaining latissimus dorsi muscle left behind.
• Once the pedicle flap is transpositioned, there should be no torsion, kinking or tension of the pedicle. ¹

References

1. Little S. C. Latissimus Myocutaneous Flap. Medscape, Clinical Procedures. 17.06.2019. https://emedicine.medscape.com/article/880878-overview#showall