Morphological and functional evidence, and clinical importance, of vascular anastomoses in the latissimus dorsi muscle of the sheep.

Mobilisation of the latissimus dorsi muscle as a functional graft necessarily involves division of perforating arteries that enter the distal portion of the muscle, rendering it vulnerable to ischaemic damage when the muscle is stimulated electrically. Using a fluorescent microsphere technique we showed that the blood flow contributed by the thoracodorsal artery decreases in a proximal-to-distal direction, and that of the perforating arteries in a distal-to-proximal direction, but for neither does the flow decline to zero. This is consistent with earlier reports of anastomotic connections between the 2 arterial territories. We went on to use fluorescence microscopy to demonstrate the existence of these vascular anastomoses, the first such evidence obtained under physiological conditions of pressure and flow. In clinical applications, the existence of anastomotic connections offers the prospect of maintaining flow to the distal part of the grafted muscle without the delays inherent in neovascularisation procedures.