1. Introduction and Surgical Approach

a. Locate Latissimus Dorsi

b. Dissection to Anterior Border of Latissimus Dorsi

c. Dissection to Posterior Border of Latissimus Dorsi

d. Test Viability of Flap

2. Flap Incisions and Dissection to Latissimus Dorsi Muscle

a. Take Down Origin and Raise Anterior Border of Flap

b. Divide Latissimus Dorsi and Raise Posterior Border of Flap

c. Identification of Thoracodorsal Artery

3. Raising Latissimus Dorsi Muscle Flap

a. Test Viability of Flap

4. Transposition

5. Reconstruction and Closure

Not only is the skin the largest organ by the surface area of the body, the integument has multiple essential functions such as preventing dehydration, acting as a first-line barrier to infection, permitting unrestricted movement of joints, as well as sustaining a normal profile and appearance. Occasionally, the treatment of breast cancer requires the removal of the breast while also leaving a large chest skin deficit. Especially if radiation has been done or is planned, the best way to restore the missing skin to preserve its essential function would be by the use of a vascularized flap. Sometimes this can be achieved while simultaneously providing a reconstruction of a very aesthetic breast mound. Depending on circumstances and the extent of disease, a simpler solution might be to just close only the chest wound that has been created. A “workhorse” flap alternative that is almost always available to achieve this is the latissimus dorsi (LD) muscle from the back, as this can be moved to almost all regions of the chest. The LD muscle usually can be swung to the chest about its blood vessels that remain attached to the armpit, and so would be called a local flap that as such avoids the complexities of a transfer requiring microsurgery to reconnect the blood supply. The long-term experience by reconstructive surgeons in using the LD muscle as a local flap, not just for the chest but also the back, head, and neck, has proven its deserved accolade to be a versatile flap unparalleled by most other donor sites. 


Watch this full-length, narrated surgical video of a left mastectomy wound closure using a latissimus dorsi musculocutaneous local flap performed in Honduras during a surgical mission with the World Surgical Foundation.

Hospital Leonardo Martinez, Honduras