Free latissimus dorsi muscle transfer using an endoscopic technique.

Endoscopic techniques in plastic surgery have involved aesthetic procedures such as facelift, breast augmentation, abdominoplasty, and placement of tissue expanders. Recently, endoscopic harvest of the donor tissue for free flap transfer has included the omentum, jejunum, latissimus dorsi muscle, and rectus abdominis muscle. Ten patients with a soft-tissue defect in the lower extremity were successfully reconstructed from December 1994 to October 1995 with a free muscle transfer after endoscopic harvest of the latissimus dorsi muscle. Nine patients were male and 1 patient was female. A 5- to 6-cm incision was initially made along the posterior axillary line, allowing direct identification of the thoracodorsal vascular pedicle. The latissimus dorsi muscle was dissected posteriorly until the limits of open dissection were reached, and then the dissection was continued under endoscopic visualization. The largest harvested muscle was 15 x 25 cm in size. Follow-up ranged from 6 to 15 months. We believe that plastic surgeons can take advantage of endoscopic techniques to obtain reliable and safe results, with smaller scars and reduced postoperative donor site morbidity such as pain and wound-healing problems. This technique may prove particularly applicable to women, children, and patients who are prone to hypertrophic scars.