Latissimus dorsi musculocutaneous flap without muscle

The possibility of raising the cutaneous island of the latissimus dorsi musculocutaneous flap without muscle based on only one cutaneous perforator is presented in this paper. An anatomic study performed in 40 fresh cadaver specimens injected with colored latex demonstrated that the vertical intramuscular branch of the thoracodorsal artery gives off two to three cutaneous branches (perforators) that are consistently present. The largest one, measuring approximately 0.4 to 0.6 mm in diameter, provides the blood supply to a 25 x 15 cm cutaneous island. The incorporation of the proximal trunk of the thoracodorsal artery lengthens the pedicle, facilitating the anastomosis or the arc of rotation (in the case of island flaps) but does not increase the amount of tissue transferable. Five clinical cases were done with this technique without tissue necrosis or flap loss.