Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases.

The latissimus dorsi myocutaneous flap can be employed successfully in head and neck reconstruction when the size or nature of the defect precludes the use of local or regional flaps. Generous amounts of hairless skin and muscle may be transferred in one operative procedure while producing an acceptable donor defect. Certain measures may be taken to enhance dependability of the flap and minimize complications, and these are discussed. The Doppler flowmeter is helpful in ascertaining patency of the main-flap vessels preoperatively as well as in identifying specific cutaneous perforators for accurate placement of the island. Locating the paddle two-thirds of the way down the muscle ensures adequate blood supply and sufficient pedicle length for most defects between the thoracic outlet and the roof of the orbits.