Practical tips for harvesting latissimus dorsi free flap

The latissimus dorsi flap (LDF) Latissimus dorsi flap (LDF) definition is a versatile soft tissue flap with a reliable vascular pedicle traveling in a consistent location along the ventral surface of the latissimus dorsi. It can be harvested as a muscle only, myocutaneous, split muscle, bilobed, osteomyocutaneous rib, and/or as part of a subscapular system chimeric flap. For example, the chimeric flap may include elements of scapula bone, serratus anterior, and the latissimus dorsi. The pedicled myocutaneous latissimus dorsi flap has also been described as an alternative to the pectoralis major pedicled flap for head and neck reconstruction. Common indications Latissimus dorsi flap (LDF) indications for applying an LDF in the head and neck are reserved for defects with large surface area and volume loss, such as extensive neck and scalp defects. A maximum dimension of 20 × 40 cm may be harvested. The thoracodorsal perforator flap (TDAP) Thoracodorsal perforator flap (TDAP) is a variation of the LDF that offers a thinner flap by splitting latissimus dorsi along the myocutaneous perforators without harvesting a significant portion of the muscle itself. The TDAP can be used for thinner, small- to medium-sized defects with a maximum dimension of 25 × 14 cm. Although the LDF can be harvested as a pedicled or free tissue transfer, it is not a standard "workhorse" flap Latissimus dorsi flap (LDF) "workhorse" flap for head and neck patients due to the availability of the anterolateral thigh flap. The harvest can be limited by lateral decubitus or prone positioning. This can prevent a two-team approach, head and neck ablation, and reconstruction from working effectively simultaneously. The LDF or TDAP Thoracodorsal perforator flap (TDAP) free flaps' vascular pedicle is based on the thoracodorsal artery and single vena comitans. The thoracodorsal artery is a continuation of the subscapular artery distal to the branch point of the circumflex scapular artery. The thoracodorsal artery immediately divides after perforation into the deep side of the latissimus into the lateral and medial branches. The vascular pedicle is consistent with less variability when compared to the ALT flap. The innervation of the latissimus dorsi muscle is from the thoracodorsal nerve, which arises from the posterior branch of the brachial plexus. It has multiple branches which run with the named vascular branches. The sensory nerve innervation arises from the ventral and dorsal rami of the thoracic spinal nerves. The purpose of this chapter is to review pearls and pitfalls for practical tips for harvesting latissimus dorsi free flap.