Technical aspects of the latissimus dorsi myocutaneous flap in breast reconstruction

The authors review the technical refinements that have come about through their increased use of the latissimus dorsi flap for reconstruction of the female breast following mastectomy, referring to over 90 of their cases. These refinements involve careful selection of patients in whom the flap is used; planning the flap, including determination of the limits of the muscle; and the location and shape of the skin island. Placement of the patient on the table and the position of her arms and hips are discussed. The dissection and transfer of the flap, as well as closure of the donor defect, can present particular problems, which are outlined. Implant placement, wound closure, and postoperative care of the patient are also discussed.