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

The LD flap is a good choice for reconstruction of the chest. However, the flap is normally not thicker than 2-3 cm. Therefore, it is usually necessary to combine this with an implant in secondary breast reconstruction. As this also results in all the disadvantages of implant-based breast reconstruction, this is nowadays more of a back-up procedure or is used if a previous reconstruction with autologous tissue has failed.

There are no absolute contraindications for this procedure. However, in cases of former radiation of the thorax or axilla, the thoracodorsal artery may be compromised as a vascular supply. This also applies to cases of previous axillary node dissection.

Patients who already have a compromised adduction of the should joint, where a reduction of movement in the joint is considered unacceptable, the surgeon should consider other options. This also includes cases of previous radical neck dissection and sacrifice of the accessory nerve, resulting in loss of function of the trapezius muscle may subsequently result in shoulder problems. ¹

Furthermore, bilateral removal of the latissimus dorsi muscle is not recommended in case of bilateral breast reconstruction.

The patient is informed of the risks associated with the procedure and possible outcomes:

• Donor site complications such as:
  • Seroma formation.
  • Cutaneous fistula.
  • Delayed wound heeling.
  • Formation of hematoma.
• Long-term complications such as:
  • Some functional loss of function of the shoulder joint.¹

Advantages

• Because of its long pedicle, it provides a good range for pedicle flap.
• The vascular anastomoses are technically less difficult because of the pedicle’s great caliber.
• A good second alternative for patients who are not candidates for reconstruction using a TRAM, DIEP or SIEA flap, e.g. previous abdominal plastic surgery or insufficient amounts of abdominal tissue. 2
• The application of this flap does not limit the use of flaps from other regions. ¹
• The donor site allows harvesting the flap of various positions, and of various components, such as muscle, fascia and bone. 3

Disadvantages

• The harvest of the latissimus dorsi muscle requires all the muscles of the shoulder joint intact and functional, in order to preserve the shoulder movement. ¹
• Long scar on the back.
• Usually it must be combined with an implant for breast reconstruction.

References

1. Little S. C. Latissimus Myocutaneous Flap. Medscape, Clinical Procedures. 17.06.2019. https://emedicine.medscape.com/article/880878-overview#showall 
2. Sood R. et Al. Latissimus Dorsi Flap in Breast Reconstruction: Recent Innovations in the Workhorse Flap. Cancer Control, 2018.
3. Kim J. T. et Al. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 344 Latissimus Dorsi Flaps From a Universal Donor Site. Annals of Plastic Surgery, 2015.