title: Clinical analysis of 33 flow-through latissimus dorsi flaps.
abstract: BACKGROUND
  Indications for flow-through latissimus dorsi (LD) flaps have been limited for reconstructing distal extremities. In addition, there has been little discussion in regard to the question of which branch is most suitable as a distal runoff of the flow-through anastomosis. The aims of this study were to investigate the feasibility of flow-through LD flaps in various areas in the body and the rationale for branch selection for the distal runoff vessel.
  
  
  METHODS
  This retrospective study included 33 patients who underwent reconstruction of an oncology-related defect with a free flow-through LD flap. Defect locations, branches used for the distal runoff, and postoperative complications were investigated.
  
  
  RESULTS
  The defect location was in the lower extremity in 13 patients, the scalp in seven, the upper extremity in six, the pelvis in six, and the chest in one. In 19 of the 33 patients, the defects were located in areas other than the distal extremities. The circumflex scapular artery (CSA) was most frequently used as the distal runoff vessel (24 patients) followed by the serratus anterior branch (SAB) (five patients). All flaps were transferred successfully without anastomotic failure.
  
  
  CONCLUSIONS
  The flow-through LD flap is a reliable option for reconstruction in many areas of the body. It can provide high success rates not only for extremity reconstruction but also for scalp and pelvic reconstruction. The CSA matches well with the workhorse recipient vessels. The SAB is suitable when there is a vascular defect of the recipient artery.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Electronic address: shimiyam@ncc.go.jp.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kawahiwa, Chiba 277-8577, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000098:blood supply / Q000637:transplantation*; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000502:physiology / Q000601:surgery*; D055815:Young Adult
keywords: Circumflex scapular; Flow-through; Latissimus dorsi; Serratus anterior branch; Thoracodorsal artery perforator