Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas.
Plast Reconstr Surg. 2012 Dec;130(6):776e-787e. doi: 10.1097/PRS.0b013e31826d9c5e.
Increasing focus on reducing morbidity from latissimus dorsi flaps has led to the evolution of muscle-sparing variants and perforator-based flaps. This study aimed to investigate the vascular anatomy of the muscle-sparing variant and to describe its application as a free flap based on the descending branch of the thoracodorsal artery.
Twelve fresh cadavers underwent anatomical dissection and angiographic injection studies of the thoracodorsal arterial system. The musculocutaneous territories of the descending and transverse branches to the latissimus dorsi muscle were identified and assessed using three-dimensional reconstruction software of computed tomography imaging results. In the clinical study, five patients underwent reconstruction of a variety of defects using the free descending branch muscle-sparing latissimus dorsi flap.
Three- and four-dimensional (computed tomography) angiography demonstrated perfusion of the latissimus dorsi muscle by the transverse and descending branches, with overlap of vascular territories via cross-linking vessels. The descending branch supplied a slightly greater cutaneous area overlying the muscle, although differences between both branches were not significant (p = 0.76). In the clinical study, the free muscle-sparing latissimus dorsi flap provided excellent coverage with no flap complications or seroma.
The free muscle-sparing latissimus dorsi flap based on the descending branch of the thoracodorsal artery is a viable reconstructive option. Significant collateral flow between vessels allows for larger flap harvest than would be expected. The flap is technically simple to harvest, provides a large perfusion area, and is a reliable variant of the full latissimus dorsi flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
越来越关注减少 Latissimus dorsi 皮瓣的发病率，导致了肌肉保留变体和穿支皮瓣的发展。本研究旨在研究肌肉保留变体的血管解剖结构，并描述其基于胸背动脉降支的游离皮瓣的应用。
12 具新鲜尸体进行了胸背动脉系统的解剖学和血管造影注射研究。使用三维重建软件对 CT 成像结果进行评估，确定和评估 Latissimus dorsi 肌肉的降支和横支的肌皮区域。在临床研究中，5 例患者使用游离降支肌保留 Latissimus dorsi 皮瓣重建了多种缺损。
三维和四维（CT）血管造影显示，Latissimus dorsi 肌肉由横支和降支供血，通过交联血管有血管区域重叠。降支供应的肌肉上方皮区略大，但两分支之间的差异无统计学意义（p = 0.76）。在临床研究中，游离肌保留 Latissimus dorsi 皮瓣提供了良好的覆盖，无皮瓣并发症或血清肿。
基于胸背动脉降支的游离肌保留 Latissimus dorsi 皮瓣是一种可行的重建选择。血管之间的显著侧支血流允许比预期更大的皮瓣采集。该皮瓣技术上易于采集，提供较大的灌注区域，是全 Latissimus dorsi 皮瓣的可靠变体。
临床问题/证据水平：治疗，V。
