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Standard autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The LD muscle is a broad, flat muscle measuring up to 25 cm × 35 cm located in the postero-inferior aspect of the trunk. It originates from the iliac crest, lower six thoracic vertebrae, and the lower four ribs and inserts into the inter-tubercular groove of the humerus. It is classified as a Mathes type V muscle with a primary blood supply from the thoracodorsal artery along with secondary segmental pedicles from perforators of the posterior intercostal arteries and the lumbar arteries.3 It is innervated by the thoracodorsal nerve, the vascular pedicle is usually accompanied by two veins, and pedicle length is around 8 cm.
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The third part of the axillary artery has three branches: the sub-scapular artery, the anterior circumflex humeral artery, and the posterior circumflex humeral artery. As its name indicates, the subscapular artery runs inferiorly near the subscapular nerves. It then divides into the thoracodorsal artery—which, like the thoracodorsal (or middle subscapular) nerve, goes to the latissimus dorsi—and the circumflex scapular artery that goes to muscles of the posterior surface of the scapula. The anterior and posterior circumflex humeral arteries course, respectively, ante-riorly and posteriorly to the surgical neck of the humerus, the latter artery passing through the quadrangular space of the back together with the axillary nerve (Plate 4.7b). Why does the body have circumflex blood vessels that surround a skeletal structure (e.g., the scapula or humerus) to meet with their counterparts? The answer is that such a circulatory anastomosis (connection)—between arteries or between veins provides a backup route for the flow of blood if one route is blocked or compromised.
Chest wall masses and chest wall resection
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Anna Maria Ciccone, Camilla Vanni, Federico Venuta, Erino Angelo Rendina
Anterior and lateral are the most common defects after chest wall tumor resection. The muscle flap of choice is the latissimus dorsi, which can be used as a myocutaneous flap or as a muscular flap. The thoracodorsal artery, a terminal branch of the subscapular artery, contributes the major blood supply, but it can be carried on the serratus collateral vascular plexus. Due to its long pedicle, a latissimus dorsi flap can be used to cover any area of the chest. (See Figure 4.5a and b.)
Latissimus Dorsi Myocutaneous Flap Procedure in a Swine Model
Published in Journal of Investigative Surgery, 2021
Joanna W. Etra, Samuel A. J. Fidder, Christopher M. Frost, Franka Messner, Yinan Guo, Dalibor Vasilic, Sarah E. Beck, Steven Bonawitz, Gerald Brandacher, Damon S. Cooney
The muscle is bordered by the slightly superficially overlapping trapezius muscle cranial-dorsally, the underlying serratus on the caudal and ventral sides, and the triceps muscle where the tendon dives to insert onto the humerus (Figures 1 and 3, Panel 3). The latissimus muscle fans from its insertion in the posterior axillary fold superficial to a fascial layer. The neurovascular bundle – containing the thoracodorsal artery, vein, and nerve – is found on the deep surface of the muscle superficial to the fascia (Figure 4). The pedicle runs deep to the teres major and enters the latissimus muscle distal to its tendon origin [17,18]. The thoracodorsal nerve – which supplies the motor innervation for the latissimus muscle – runs parallel to the vascular bundle inserting slightly more cranially. The nerve is easily identified and accessed for a neurotized flap model.
Muscle flaps for sternoclavicular joint septic arthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Barkat Ali, Timothy R. Petersen, Anil Shetty, Christopher Demas, Jess D. Schwartz
Latissimus dorsi is the next local flap option for closure of sternoclavicular joints. This is a type V flap which consists of a large vascular pedicle, and known secondary pedicles. The thoracodorsal artery is the main pedicle, with secondary pedicles from the posterior intercostal artery. Innervation is through the thoracodorsal nerve [23]. If pectoralis major muscle is not available because of pedicle sacrifice, or there is need for skin paddle, or there is need for more bulk in addition to the pectoralis major, then we recommend latissimus dorsi based on thoracodorsal pedicle. Although skin graft can be performed over pectoralis muscle flap, in our experience bringing skin paddle with latissimus dorsi is more aesthetically pleasing and potentially offers faster recovery. The functional deficit following latissimus dorsi flap is insignificant [24]. The two patients who needed latissimus dorsi flaps in our series were because of the unavailability of the pectoralis major muscle from previous operations, including one patient who needed skin paddle resulting from debridement of the skin
Free latissimus dorsi flap for upper extremity reconstruction in a 9-month-old
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Ryan D. Wagner, Jacqueline S. Yang, Brittany E. Bryant, William C. Pederson, Shayan A. Izaddoost
The safety, success rates, and outcomes of free tissue transfer in the pediatric patient population have been well documented in the literature by numerous reviews and case series [1,2,13]. Free flaps are utilized to reconstruct a wide range of pediatric defects – including oncologic, traumatic, and congenital. However, significantly less literature is available on the implementation of free tissue transfer in reconstruction for infants. Indications and outcomes are largely limited to a select few case reports [14–17]. The decision to proceed with free tissue transfer, in this case, was determined by the extensive scarring and impaired skeletal growth. Skin grafting or the use of dermal regeneration templates would not bring in new well-vascularized tissue with a concern for subsequent contracture with later growth. The size of the lesion and the location on the dorsal forearm with underlying extensor tendons prohibited local options for coverage. Without this operation, the patient would have likely developed a permanent and significant functional deformity. The latissimus dorsi flap was chosen as the donor because of the size of the defect, low donor site morbidity, relative ease of dissection, and consistent vascular anatomy with a large caliber vessel in the thoracodorsal artery. The size and availability of donor tissues are problematic in the infant population and fasciocutaneous flaps can be too small for coverage of large wounds. The latissimus dorsi flap was the donor site of choice for many of the published reports of free tissue transfer in infants [14,16,17].