THE LATISSIMUS-DORSI PERFORATOR-BASED FASCIOCUTANEOUS FLAP

The latissimus dorsi musculocutaneous flap has proven utility in the r econstruction of defects of the breast, chest wall, head and neck, and upper extremity. As a free flap, the latissimus dorsi has become a ma instay for the coverage of severe traumatic tibial/fibular wounds. We describe a new and useful extension of the latissimus dorsi musculocut aneous unit that consists of a fasciocutaneous segment based on muscul ocutaneous perforators from the thoracodorsal artery, The vascular ana tomy of the flap is described and illustrated with 6 fresh human cadav eric dissections, We also present 3 cases in which in vivo dissections of this flap were performed, 2 at the time of latissimus microvascula r transfer and 1 approximately 5 days after microvascular transfer to salvage exposed fractured tibial bone successfully due to distal muscl e loss. A pedicled or free latissimus dorsi musculocutaneous flap may be reliably extended and thereby rendered more versatile through the u se of the perforator-based fasciocutaneous flap, Benefits and potentia l applications of the latissimus dorsi perforator-based fasciocutaneou s flap are discussed.