Pearls and pit-fall

Authors: Caroline Lilja, MD., Emma Tubæk Nielsen, stud.med., Magnus Balslev Avnstorp, MD., and Stephan Thunich, MD.

Pearls

The flap can be combined with other subscapular flaps.
On average, the pedicle is 7-12 cm long.
The average diameter of the thoracodorsal artery is 1.5-4 mm.
Along the anterolateral border of the muscle is where the highest density of perforators is located, making it ideal for harvest.
If a smaller skin island is desired, harvesting surrounding subcutaneous tissue allows for additional perforators, and increases the chances of flap survival.
Seroma formation can be reduced by utilizing drains, in addition of fixation of the skin with tacking sutures.
Donor scarring can be reduced with an endoscopic-assessed harvest.
Initially, the flap might be bulky in the site of reconstruction, but because of its denervation it will atrophy over time.
The biggest dimensions of the latissimus dorsi muscle is 20×40 cm.
The size of the skin paddle harvested, should not exceed 10 cm in width, in order to close the wound directly. ¹

Because the perforators are usually not identified prior to or during the surgery, there is a risk of compromised blood supply if the skin island is of a smaller size.
Whilst dissecting the neurovascular pedicle of the flap, care should be taken in to preserve the innervation of the remaining latissimus dorsi muscle left behind.
Once the pedicle flap is transpositioned, there should be no torsion, kinking or tension of the pedicle. ¹

Little S. C. Latissimus Myocutaneous Flap. Medscape, Clinical Procedures. 17.06.2019. https://emedicine.medscape.com/article/880878-overview#showall