Specific Landmark Marking

Margin:
• tip of the scapula to the
midline of the back
posteriorly, and with its
fascial extension to the
iliac crest inferiorly.
• The anterior border of the
muscle passes on an
oblique line from the
midpoint of the iliac crest
to the axilla.
Skin island dimensions:
Length: 18 cm (range up to 35 cm)
Width: 7 cm (range up to 20 cm)
Maximum to close primarily: 8-9 cm,
maximum dimension 20x35 cm
Thickness: 2.5 cm (range 1-5 cm)
Latissimus dorsi 1
Latissimus dorsi 2
• Make the initial skin
incision starting at the
posterior axillary fold
and running
posterioinferiorly
toward the iliac crest
and 3 to 5 cm posterior
to the medial border of
the latissimus dorsi
muscle.
• The first incision
exposes the anterior
edge of the latissimus
dorsi muscle between
the axilla and proximal
edge of the flap.
Dissect through the
skin and subcutaneous
tissue.

Latissimus dorsi 3
 The serratus branch should not be mistaken for the
thoracodorsal
artery. This vessel should not be transected or ligated
before the
thoracodorsal artery is clearly identified.
Proximal dissection of the vascular pedicle is facilitated if the
skin incision is extended to the onset of the posterior axillary fold.
At the level of the circumflex scapular vessels, the length of the
thoracodorsal
artery
Latissimus to the neurovascular hilum of the flap is at least 7
dorsi 4
cm.
• Secure the skin paddle to the
muscle fascia with absorbable
stitches.
• Raise anterior and posterior skin
flaps superficial to the LD muscle
fascia. Continue dissection until all
borders of the LD muscle are To prevent shearing
forces to the
visualized. perforating vessels,
the skin
• Elevate the middle portion of the paddle should be
muscle from the chest wall by fixed to the muscle
with some stay
dissecting between the latissimus sutures.
dorsi and serratus anterior muscles
starting at the lateral border.
• Continue dissection toward the
inferomedial muscle origin
(thoracolumbar fascia) until desired
amount of muscle is elevated. It
will be necessary to ligate the
branches from the intercostals and
lumbar arteries posteriorly and
perforating branches from the
chest wall proximally.

Latissimus dorsi 5
The vertical branch of the
thoracodorsal artery may be
missed.
Advice: Flap raising is
facilitated
and more reliable if the
muscle component is nearly
the same
size as the skin paddle.

The stay sutures between

the skin paddle and the
muscle should
not be removed until the
flap is fixed at the recipient
site.
Clearly visualize the neurovascular
hilum before the muscle is
transected cranially. Latissimus dorsi 6