VARIATIONS IN THE

NEUROVASCULAR PEDICLE
OF LATISSIMUS DORSI
LATISSIMUS DORSI: AN OVERVIEW
Vasculature type acc. To Mathes and
Nahai

Thoraco-Dorsal
Artery as Dominant
pedicle
 AIM
To analyse and study the variations in the insertion and branching
of the Dominant Neurovascular pedicle of Latissimus Dorsi(Type
V vascular insertion)
MATERIALS
Surgical Tape #11 and #20
blades Grant’s Dissector

Standard Dissection Kit

 METHOD OF EXCISION AND
STUDY
• The cadaver was placed in pronated position and an oblique incision
was made from the level of L2 till the bicipital groove.
• The skin and fascia over the muscle were removed and the muscle
was removed from the point of origin and retracted superiolaterally
towards its insertion.
• The NVP was exposed and was cleared of any fascia by using fine
dissection.
• Point of branching was identified with respect to level of ISA.
Method 1: Surgically Accurate
Method 2: As prescribed in Grant’s
Dissector
OBSERVATIONS
 After Dissecting 40 LD, several variations in
the point of branching and the branching
patterns itself were noted. Their frequency of
occurrence was calculated statistically.
EARLY VS LATE BRANCHING

POINT OF BRANCHING

12%

25%

38%

25%

2" SUPERIOR 1" SUPERIOR 1.5" SUPERIOR 0.4" INFERIOR

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 OBSERVATION 2: DIFFERENT BRANCHING
PATTERNS

Several variations in the branching patterns were observed. Based

on the shape that they resemble, a NEW system of classification
has been proposed.

It consists of 3 Major types of Patterns, namely:

A. V-Type
B. Spiralling type
C. Sagumate Type
 V-TYPE
Distribution Amongst Sexes

38%

62%

Males Females
SPIRALLING TYPE

Transverse View
Distribution Amongst Sexes

25%

75%

Males Females
SAGUMATE (CURTAIN-LIKE) TYPE
Distribution Amongst Sexes

20%

80%

Males Females
Percentage of Occurrence
10%

27%

63%

V-Type Spiralling Type Sagumate Type

CONCLUSION
PREVENTION OF VASCULAR DAMAGE
DUE TO SURGICAL ERROR

If the surgeon is aware of the variations in the

branching of the NVP, there can be changes
implemented in the procedure to decrease the
accidental laceration of the NVP, hence reducing
the complications related to the surgery.
 FREQUENCY OF VARIATIONS

The variations were of a higher frequency amongst females than

males, hence leading to a possibility that there is a stabilizing
factor linked with the Y-Chromosome. This has multiple
applications in genetic research.
 Significance of branching patterns
We can observe a anastomosis-like configuration in Sagumate
type NVP. This hints to a possibility that this type of muscle would
have a richer blood supply, hence increasing its efficiency.
V-type NVP shows a predictable and a highly organised
branching, hence we can have a more successful surgeries in
these cases.
Spiral Type of NVP have a greater amount of surgical risk
associated to it as they branch very early and are not generally
held together by a fascia