Specific Landmark Marking

Margin:
• tip of the scapula to the
midline of the back
posteriorly, and with its
fascial extension to the
iliac crest inferiorly.
• The anterior border of
the muscle passes on an
oblique line from the
midpoint of the iliac
crest to the axilla.
Skin island dimensions:
Length: 18 cm (range up to 35 cm)
Width: 7 cm (range up to 20 cm)
Maximum to close primarily: 8-9 cm,
maximum dimension 20x35 cm
Thickness: 2.5 cm (range 1-5 cm)
Latissimus dorsi 1
Latissimus dorsi 2
• Make the initial skin
incision starting at
the posterior axillary
fold and running
posterioinferiorly
toward the iliac
crest and 3 to 5 cm
posterior to the
medial border of the
latissimus dorsi
muscle.
• The first incision
exposes the anterior
edge of the
latissimus dorsi
muscle between the
axilla and proximal
edge of the flap.
Dissect through the
skin and
subcutaneous
tissue.
Latissimus dorsi 3
 The serratus branch should not be mistaken for the
thoracodorsal
artery. This vessel should not be transected or ligated before the
thoracodorsal artery is clearly identified.
Proximal dissection of the vascular pedicle is facilitated if the
skin incision is extended to the onset of the posterior axillary fold.
At the level of the circumflex scapular vessels, the length of the
thoracodorsal
artery to the neurovascular hilum of the flap is at least 7
cm. dorsi
Latissimus 4
• Secure the skin paddle to the
muscle fascia with absorbable
stitches.
• Raise anterior and posterior
skin flaps superficial to the LD
muscle fascia. Continue
dissection until all borders of
the LD muscle are visualized. To prevent shearing
forces to the perforating
• Elevate the middle portion of vessels, the skin
paddle should be fixed to
the muscle from the chest wall the muscle with some
by dissecting between the stay sutures.
latissimus dorsi and serratus
anterior muscles starting at the
lateral border.
• Continue dissection toward the
inferomedial muscle origin
(thoracolumbar fascia) until
desired amount of muscle is
elevated. It will be necessary to
ligate the branches from the
intercostals and lumbar
arteries posteriorly and
perforating branches from the
chest wall proximally.

Latissimus dorsi 5
The vertical branch of the
thoracodorsal artery may be
missed.
Advice: Flap raising is facilitated
and more reliable if the muscle
component is nearly the same
size as the skin paddle.

The stay sutures between the

skin paddle and the muscle
should
not be removed until the flap is
fixed at the recipient site.

Clearly visualize the neurovascular hilum

before the muscle is
transected cranially. Latissimus dorsi 6