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Latissimus Dorsi Flap

Table of Contents

ClassificationMathes & Nahai Type V
Vascular Supply

Dominant: Thoracodorsal artery 

Segmental: Paraspinous perforators  

Innervation 

Thoracodorsal Nerve

Historical Perspective

1906First described by Iginio Latini  
1970sFlap was popularized 

Advantages

Disadvantages

  • Large flap 
  • Large skin paddle 
    • Up to 20 cm length x 8-10 cm wide 
  • Constant anatomy 
  • Donor defect can be closed primarily 
  • Well concealed donor defect in clothing 
    • Can be hidden in bra line 
  • Can be chimeric on one pedicle 
    • Lower three slips of serratus anterior muscle 
    • Scapular/parascapular flap 
    • Scapular tip 
  • Requires lateral decubitus or prone positioning to harvest 
  • Prolonged serous drainage from back wound donor site 
    • Increased risk of seroma formation 
  • Resultant shoulder morbidity 
    • Most serious in paraplegics  
  • May get some winging of scapula even if serratus is left intact 

Relevant Anatomy

Origin 

  • Spinous processes  of lower six thoracic vertebrae 
  • Spinous process of lumbar vertebrae 
  • Sacral spinous processes 
  • Iliac crest via thoracodorsal fascia 
  • 10th, 11th, and 12th ribs via fibers interdigitating with external oblique and serratus anterior msucles 
  • Inferior angle of the scapula 

Insertion 

  • Medial lip of bicipital groove 

Function 

  • Humerus extension, internal rotation, adduction 
  • Stabilizes and elevates pelvis when flexing at hip 
  • Holds inferior angle of scapula to chest wall 

Complications

Seroma

  • Incidence of 9-80%, likely 40-50% on average