Latissimus Dorsi Flap

A latissimus dorsi flap moves the broad, flat latissimus muscle of the back, often with an island of the skin over it, to another part of the body. The muscle is fed by the thoracodorsal vessels, which run along its deep surface. Its most common use is breast reconstruction after mastectomy, when there is a large tissue loss or when a TRAM flap is not an option. It is also used to cover large defects of the chest, head and neck, and as a muscle transfer for facial reanimation. For the breast, the flap is usually pedicled: it stays attached to the upper arm bone and to its own blood vessels and is swung through a tunnel under the armpit to the front of the chest. To make a more natural breast mound, a breast implant is usually placed under it. The flap can also be moved as a free flap, where the vessels are cut and reconnected at the new site with microsurgery. What makes this case different for the scrub is the position change: the flap is harvested with the patient on the side (or prone), the back is closed, and the patient is turned supine to finish the chest. The operation is done under general anesthesia, and blood loss can be significant, so a type and screen is done beforehand. The most serious complication is partial or complete flap loss from poor blood flow in the first weeks of healing. Bleeding and hematoma at the back or chest are prevented with careful hemostasis. Prior injury or surgery that damaged the flap's blood supply rules it out; smoking, diabetes and poor vascular health raise the risk.