title: The free descending branch muscle-sparing latissimus dorsi flap:  vascular anatomy and clinical applications.
abstract: BACKGROUND
  Increasing focus on reducing morbidity from latissimus dorsi flaps has led to the evolution of muscle-sparing variants and perforator-based flaps. This study aimed to investigate the vascular anatomy of the muscle-sparing variant and to describe its application as a free flap based on the descending branch of the thoracodorsal artery.
  
  
  METHODS
  Twelve fresh cadavers underwent anatomical dissection and angiographic injection studies of the thoracodorsal arterial system. The musculocutaneous territories of the descending and transverse branches to the latissimus dorsi muscle were identified and assessed using three-dimensional reconstruction software of computed tomography imaging results. In the clinical study, five patients underwent reconstruction of a variety of defects using the free descending branch muscle-sparing latissimus dorsi flap.
  
  
  RESULTS
  Three- and four-dimensional (computed tomography) angiography demonstrated perfusion of the latissimus dorsi muscle by the transverse and descending branches, with overlap of vascular territories via cross-linking vessels. The descending branch supplied a slightly greater cutaneous area overlying the muscle, although differences between both branches were not significant (p = 0.76). In the clinical study, the free muscle-sparing latissimus dorsi flap provided excellent coverage with no flap complications or seroma.
  
  
  CONCLUSIONS
  The free muscle-sparing latissimus dorsi flap based on the descending branch of the thoracodorsal artery is a viable reconstructive option. Significant collateral flow between vessels allows for larger flap harvest than would be expected. The flap is technically simple to harvest, provides a large perfusion area, and is a reliable variant of the full latissimus dorsi flap.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas.
authors.forename: Shannon
authors.initials: S
authors.lastname: Colohan
authors.forename: Corrine
authors.initials: C
authors.lastname: Wong
authors.forename: Chrisovalantis
authors.initials: C
authors.lastname: Lakhiani
authors.forename: Angela
authors.initials: A
authors.lastname: Cheng
authors.forename: Munique
authors.initials: M
authors.lastname: Maia
authors.forename: Gary
authors.initials: G
authors.lastname: Arbique
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001158:Arteries; D005260:Female; D056973:Four-Dimensional Computed Tomography; D058752:Free Tissue Flaps / Q000098:blood supply*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery; D016896:Treatment Outcome