title: Survival of a pedicled latissimus dorsi flap in breast reconstruction without a thoracodorsal pedicle.
abstract: The latissimus dorsi flap, first performed by Tansini in 1892, was popularised for use by Olivari in 1976. The successful transfer of a latissimus dorsi flap during breast reconstruction has previously been thought to be dependent on having an intact thoracodorsal pedicle to ensure flap survival. It is well documented that the flap may also survive on the serratus branch in thoracodorsal pedicle division. We report a case of a 52-year-old female patient who underwent successful delayed breast reconstruction with a latissimus dorsi flap following previous mastectomy and axillary node clearance. Intraoperatively, the thoracodorsal pedicle and serratus branch were found to have been previously divided. On postoperative computer tomographic angiography the thoracodorsal pedicle was shown to be divided together with the serratus branch. The flap was seen to be supplied by the lateral thoracic artery. To our knowledge survival of a pedicled latissimus dorsi flap in breast reconstruction with a vascular supply from this vessel following thoracodorsal pedicle division has not previously been described. Previous thoracodorsal pedicle and serratus branch division may not be an absolute contraindication for the use of the latissimus dorsi flap in breast reconstruction, depending on the results of preoperative Doppler or computer tomographic angiography studies.
authors.affiliation: Department of Plastic Surgery, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom. ceahartmann@gmail.com
authors.forename: C E A
authors.initials: CE
authors.lastname: Hartmann
authors.forename: O A
authors.initials: OA
authors.lastname: Branford
authors.forename: A
authors.initials: A
authors.lastname: Malhotra
authors.forename: J S
authors.initials: JS
authors.lastname: Chana
mesh_terms: D000792:Angiography / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000637:transplantation; D012039:Regional Blood Flow / Q000502:physiology; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000000981:diagnostic imaging*; D016896:Treatment Outcome