Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution

Watanabe, Koichi; Kiyokawa, Kensuke; Rikimaru, Hideaki; Koga, Noriyuki; Yamaki, Koh-ichi; Saga, Tsuyoshi

doi:10.1016/j.bjps.2009.05.042

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 63, Issue 7 , Pages 1091-1098, July 2010

Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution

Koichi Watanabe
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi Kurume, Fukuoka 830-0011, Japan
Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi Kurume, Fukuoka 830-0011, Japan
- Corresponding author. Tel./fax: +81 942 34 0834.
Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi Kurume, Fukuoka 830-0011, Japan
Noriyuki Koga
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi Kurume, Fukuoka 830-0011, Japan
Koh-ichi Yamaki
- Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
Tsuyoshi Saga
- Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan

Received 17 July 2008; accepted 18 May 2009. published online 08 July 2009.

Summary

Background

The objective of the current study is to elucidate the three-dimensional vascular distribution as far as the peripheral areas of a latissimus dorsi musculocutaneous flap and to establish a safe procedure for creating it.

Methods

A lead oxide with gelatin-contrast agent was injected into fresh cadavers and the angiosomes in the muscle and skin were examined in detail.

Results

In the muscle, three vascular territories were observed. The first vascular territory was formed by the thoracodorsal artery, the perforating branches of the ninth intercostal artery and those of the tenth intercostal artery located in the lateral part of the muscle. The second vascular territory was formed by the perforating branches of the tenth intercostal artery located in the medial part of the muscle, those of the 11th intercostal artery and the subcostal artery. The third vascular territory was formed by perforating branches of the first and second lumbar arteries.

In the dorsal skin above the muscle, two vascular territories were observed. The first vascular territory was formed by perforating cutaneous branches of the thoracodorsal artery, perforating branches of the ninth through 11th intercostal arteries and the scapular circumflex artery. The second vascular territory was formed by perforating branches of the subcostal artery and the first and second lumbar arteries.

Conclusions

When using a latissimus dorsi musculocutaneous flap with the thoracodorsal artery as a pedicle, the flap can be safely elevated as far as the inferior border of the 12th rib where perforating branches of the subcostal artery are distributed. At the same time, skin above the muscle can be safely harvested up to the iliac crest. It is essential, however, that the skin paddle includes perforating branches of the ninth intercostal artery or perforating branches of the 10th intercostal artery in the lateral part of the muscle.

Keywords: Latissimus dorsi musculocutaneous flap, Vascular territory, Angiosome, Choke vessels, Safety elevation area of flap