Craniofacial and head and neck applications of the transaxillary latissimus dorsi flap

The use of a transaxillary latissimus dorsi musculocutaneous flap is suitable whenever a large volume of tissue is required for head and neck reconstruction. Our series of 63 transaxillary latissimus dorsi musculocutaneous flap reconstructions included three cases of complete flap necrosis and ten cases of partial flap necrosis. When used in reconstructive head and neck surgery, the latissimus dorsi vascular pedicle is separate from the radiated field. The pedicled latissimus dorsi flap provides coverage of the orbitocranium, including the supraorbital region and central portion of the upper face. In the event that the pedicle muscle flap does not reach far enough cephalad, the nutrient vessels can be separated from the axillary artery and anastomosed to vessels in the neck. Combined defects of the esophagus, the mandibulofacial region, and the neck may be reconstructed with a single large latissimus dorsi flap. In our experience, aesthetic and functional deficits have been well tolerated by patients after latissimus dorsi reconstruction. Disadvantages of the latissimus dorsi flap include repositioning of the patient, increased blood loss, and longer operating time. Permanent brachial plexus injury can also occur. In general, the transaxillary latissimus dorsi musculocutaneous flap should not be used when defects can be reconstructed using simpler methods.