The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer

The latissimus dorsi (LD) muscle is a workhorse flap in reconstructive surgery (e.g., breast reconstruction, chest wall defects, and lower limb trauma). The thoracodorsal artery and its venae comitantes supply this muscle. Recipient vessel options for microsurgical free flap reconstruction of the posterior thorax and lower back are limited. The thoracodorsal vessels are an excellent option due to their reliable anatomy and ease of access. In circumstances when the patient is best positioned prone, the posterior approach to access the thoracodorsal vessels is advantageous. We describe the technique to identify and isolate these vessels via a posterior approach.