Latissimus Dorsi Musculocutaneous Flap for Pharyngoesophageal Reconstruction



Latissimus Dorsi Musculocutaneous Flap for Pharyngoesophageal Reconstruction


F. E. BARTON JR.

J. M. KENKEL

W. P. ADAMS JR.



Despite recent advances in microsurgical techniques, regional pedicled flaps remain the mainstay of reconstructive options for pharyngoesophageal reconstruction. The island pectoralis major musculocutaneous flap continues to be the preferred flap of many reconstructive surgeons; however, the latissimus dorsi musculocutaneous flap is a safe and reliable alternative for reconstruction of partial and circumferential cervical esophageal defects (1, 2, 3).




ANATOMY

The latissimus dorsi is a flat muscle extending obliquely across the back. It originates from the lower six thoracic vertebrae, lumbar and sacral vertebrae, iliac crest, and external surface of the lower four ribs, and it inserts on the intertubercular groove of the humerus (5, 6). The neurovascular anatomy of the latissimus dorsi flap was expertly described previously (7, 8, 9, 10, 11). The thoracodorsal artery originates from the subscapular artery and is the principal blood supply to the latissimus dorsi muscle. One to three arterial branches to the chest wall are given off before the thoracodorsal artery enters the latissimus dorsi muscle (7). The neurovascular pedicle enters the muscle on its undersurface about 8 to 10 cm from its origin (8) and 8 to 12 cm below its humeral insertion. The vessels bifurcate about 2 cm after entering the muscle. The superior branch traverses the muscle parallel to its border approximately 3.5 cm from the upper edge. The lateral branch parallels the posterior border of the muscle some 2 cm from its edge (7). Cutaneous perforators emanate from these branches and appear at regular patterns 3 to 5 cm apart (1, 12, 13). In cadaveric injection studies of the thoracodorsal artery, the lower third of the muscle and its overlying skin consistently do not fill with contrast medium, which indicates this portion of the muscle and skin are unreliable for use as a musculocutaneous flap (1, 12).

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Latissimus Dorsi Musculocutaneous Flap for Pharyngoesophageal Reconstruction
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