title: Latissimus dorsi flaps oriented on the lateral intercostal artery perforators: anatomical study and application in autologous breast reconstruction.
abstract: Autologous breast reconstruction with the latissimus dorsi (LD) musculocutaneous flap has several problems including scarcity of tissue and postoperative atrophy of muscles. We report a modification of the flap based on a re-evaluation of the intramuscular and perforating vascular anatomy focused on the intercostal vascular system. Our anatomical study confirmed the following technical improvements: splitting of the muscle oriented along the 10(th) posterior intercostal artery; siting the axis of the flap on the centre of the 10(th) lateral intercostal artery perforator to obtain ample subcutaneous fat cranial to the iliac crest; and enclosing the dermoadipofascial flap around the split muscular pedicle. These flaps were used in 12 patients who required reconstruction without implants. The results showed a consistent volume of tissue and shape, and less donor site morbidity. Our modifications can be used to improve the three-dimensional potential of the LD flap in autologous breast reconstruction.
authors.affiliation: Department of Plastic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan. minabe@saitama-med.ac.jp
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Minabe
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Imanishi
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000033:anatomy & histology / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D002102:Cadaver; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply / Q000601:surgery; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000098:blood supply / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000502:physiology