F Boucher1, B Pinatel2, H Shipkov2, P Mertens3, O Rouviere4, F Braye2, A Mojallal2. 1. Service de chirurgie plastique, reconstructrice et esthétique, université Claude-Bernard-Lyon 1, hôpital de la Croix-Rousse, centre hospitalier universitaire, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: fabienboucher@orange.fr. 2. Service de chirurgie plastique, reconstructrice et esthétique, université Claude-Bernard-Lyon 1, hôpital de la Croix-Rousse, centre hospitalier universitaire, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France. 3. Département universitaire d'anatomie Rockefeller, université Claude-Bernard-Lyon 1, 8, avenue Rockefeller, 69008 Lyon, France. 4. Service de radiologie vasculaire-pavillon P, centre hospitalier universitaire Edouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
Abstract
INTRODUCTION: The latissimus dorsi muscle flap is a type V according to Mathes and Nahai. It is vascularized by a proximal main pedicle represented by the thoraco-dorsal pedicle and pedicle distal accessory represented by the dorsal branches of the posterior intercostal arteries. The main thoraco-dorsal pedicle has a descending branch and a transverse branch. This anatomical study clarifies the muscular territory vascularized by the transverse branch of thoraco-dorsal artery for a secondary use after harvesting a thoraco-dorsal artery perforator flap or a muscle-sparing latissimus dorsi flap. MATERIAL AND METHODS: Our study focused on ten dissections latissimus dorsi muscle taken from five fresh cadavers chest, carried out within the University Department of Anatomy. The descending branch of thoraco-dorsal artery was ligated, the transverse branch was cannulated and injected with a mixture of barium sulfate/gelatin. After freezing, a static angiotomodensitometry (3D) of each flap was performed. RESULTS: The average muscular surface vascularized by the transverse branch is measured at 80% (77% minimum value, maximum value 83%) of the complete latissimus dorsi muscle. Intermuscular connections between the two branches of thoraco-dorsal pedicle were shown. CONCLUSION: The use of a ipsilateral latissimus dorsi muscle is a therapeutic option after harvesting a thoraco-dorsal artery perforator flap (TAP) or a muscle-sparing latissimus dorsi flap (MSLD-flap).
INTRODUCTION: The latissimus dorsi muscle flap is a type V according to Mathes and Nahai. It is vascularized by a proximal main pedicle represented by the thoraco-dorsal pedicle and pedicle distal accessory represented by the dorsal branches of the posterior intercostal arteries. The main thoraco-dorsal pedicle has a descending branch and a transverse branch. This anatomical study clarifies the muscular territory vascularized by the transverse branch of thoraco-dorsal artery for a secondary use after harvesting a thoraco-dorsal artery perforator flap or a muscle-sparing latissimus dorsi flap. MATERIAL AND METHODS: Our study focused on ten dissections latissimus dorsi muscle taken from five fresh cadavers chest, carried out within the University Department of Anatomy. The descending branch of thoraco-dorsal artery was ligated, the transverse branch was cannulated and injected with a mixture of barium sulfate/gelatin. After freezing, a static angiotomodensitometry (3D) of each flap was performed. RESULTS: The average muscular surface vascularized by the transverse branch is measured at 80% (77% minimum value, maximum value 83%) of the complete latissimus dorsi muscle. Intermuscular connections between the two branches of thoraco-dorsal pedicle were shown. CONCLUSION: The use of a ipsilateral latissimus dorsi muscle is a therapeutic option after harvesting a thoraco-dorsal artery perforator flap (TAP) or a muscle-sparing latissimus dorsi flap (MSLD-flap).