|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
The latissimus dorsi muscle is the largest single transplantable block of vascularized tissue. It is one of the most versatile free flaps available. Its size allows it be used to cover defects of great magnitude. The ability to tailor and trim the muscle, taking only the size required, dramatically increases its versatility. The muscle is extremely malleable and may be folded, turned, rolled under, and stuffed into cavities and wounds of all sizes and shapes. Because of this considerable versatility and its great accessibility, the latissimus dorsi muscle has been used for difficult coverage problems over all parts of the body.1-5
The dominant vascular pedicle to the latissimus dorsi muscle from the subscapular- thoracodorsal vascular axis makes this muscle readily accessible and suitable for microvascular transplantation. The intact pedicle can be rotated about the apex of the axilla, allowing the muscle to be used as an island for large reconstructive problems of the chest, shoulder, breast, back, and neck. On its pedicle, it can be used as a functional transplant to replace any major muscle about the shoulder, arm, or forearm.
Microvascular transplantation of the latissimus dorsi muscle with split-thickness skin-graft coverage has been used primarily for extensive wounds of the scalp and skull and for massive wounds of the lower extremities.6-11 Almost the entire skull may be covered with one latissimus dorsi muscle flap.12 When the serratus is carried with the latissimus dorsi, even greater areas can be covered, for example, the anterior and posterior compartments of the leg, mirror image wounds on extremities,13 and double functional muscle transplants. Similarly, the entire lower leg between the knee and ankle, either anteriorly or posteriorly, may be covered by one latissimus dorsi muscle flap. The flap is particularly useful in covering large areas of exposed alloplastic materials such as extensive plates of the lower extremity or the skull. The muscle has been shown to tolerate well the presence of the foreign material as well as of low-grade infection.
The latissimus muscle has also been used as a free flap in extensive coverage problems of the hip and the upper extremity. In the former location, the muscle may be literally stuffed into a large open wound of the hip to provide well vascularized tissue to fill an extensive dead space after removal of total hip hardware or tumors. The rectus abdominis on an intact vascular pedicle can be similarly transferred.
When used as a muscle alone, the latissimus dorsi donor site may always be closed primarily, obviating the need for a skin graft on the exposed area of the back. The loss of the latissimus dorsi muscle and the location of the specific donor-site scar have not been objectionable to patients undergoing free latissimus dorsi muscle transplantation.
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