An anatomic study of the latissimus dorsi-rib flap: an extension of the subscapular combined flap.

The anatomy of the vascular perforators between the latissimus branch of the thoracodorsal vessels and the lateral branch of the dorsal rami of the intercostal vessels was studied in a series of 10 dissections in 5 preserved cadavers to develop the latissimus dorsi myocutaneous flap combined with a vascularized rib. The distances between the communicating perforators and the spinous process and the iliac crest, which become a good guide for design of the rib flap, were measured. An extension of the combined flap including the scapular osteocutaneous flap, latissimus dorsi myocutaneous flap, and vascularized eleventh and twelfth ribs that is nourished by a "single" subscapular vascular system was demonstrated. This technique, which provides a large amount of skin, muscle, and bone, is very effective for reconstruction of an extended composite maxillary and mandibular defect.