The latissimus dorsi has proved especially useful in resurfacing defects of the cheek and lateral scalp. Although most of the neck can be reached for coverage by the latissimus dorsi, the pectoralis major is generally preferred for neck and intraoral reconstruction. The latissimus dorsi is used in these areas when a great deal of bulk or skin or both are needed (1, 2, 3, 4, 5, 6, 7).

For reestablishing oropharyngeal continuity, the musculocutaneous flap has been used with the skin portion placed inward and with skin grafts placed on the exposed muscle surface (8). The split flap, with two musculocutaneous units, has been applied to reconstruction of the pharynx while simultaneously providing outer skin coverage (9, 10).

The free latissimus dorsi flap was first described for coverage of a chronically infected scalp after multiple skin grafts had failed (11). Since that time, the free latissimus dorsi has been used as a muscle alone with skin graft cover (12, 13), as a musculocutaneous flap both for scalp and other head and neck defects (14, 15), and as an osteomusculocutaneous composite transfer to achieve internal and external wound closure and to restore mandibular continuity (16). Whenever possible, however, the long vascular pedicle of the muscle should lead to consideration of a pedicled flap rather than a free flap.