Clinical Report: Comprehensive Review of Latissimus Dorsi Flap Uses in Reconstruction
Overview
The latissimus dorsi (LD) flap is a highly versatile reconstructive option with applications spanning breast, head and neck, thorax, abdomen, pelvis, and extremities. This systematic review of 188 articles highlights both traditional soft-tissue coverage and innovative functional reconstructions, including muscle reinnervation and microsurgical advances.
Background
The LD flap, first used in 1906 for breast reconstruction, has evolved into a cornerstone of reconstructive surgery due to its reliable vascularity and large surface area. It is supplied by the thoracodorsal vessels and innervated by the thoracodorsal nerve. Recent innovations such as muscle-sparing techniques, robot-assisted harvest, and neuromuscular reinnervation have expanded its indications and improved outcomes. Despite concerns about donor site morbidity and muscle atrophy, the LD flap remains a preferred option for complex defects requiring both coverage and functional restoration.
Data Highlights
A total of 188 full-text articles were included in this systematic review. Indications were categorized anatomically: breast, head and neck, thorax and back, abdomen and pelvis, and upper and lower extremities. Functional reconstructions included innervated and non-innervated flaps for facial reanimation, limb motor restoration, urologic reconstruction (phalloplasty, detrusor myoplasty), and diaphragmatic repair. Pedicled flaps were mainly used for adjacent defects, while free flaps were preferred for distant or complex reconstructions.
Key Findings
The LD flap is adaptable for nearly all anatomical regions, serving both coverage and functional roles.
Functional applications include innervated flaps for muscle reanimation and dynamic reconstructions.
Pedicled LD flaps are predominantly used for defects adjacent to the donor site; free flaps facilitate distant and complex reconstructions.
Advances in microsurgery and muscle reinnervation have expanded the flap's reconstructive potential.
Innovations such as robot-assisted and endoscopic harvest techniques reduce donor site morbidity.
Chimeric and hybrid flap designs allow tailored reconstruction based on defect complexity and functional needs.
Clinical Implications
Surgeons should consider the LD flap as a versatile reconstructive option capable of addressing both soft tissue coverage and functional restoration across multiple anatomical sites. The choice between pedicled and free flap techniques should be guided by defect location and complexity. Incorporating muscle reinnervation and minimally invasive harvest techniques can optimize functional outcomes and reduce donor site complications.
Conclusion
The latissimus dorsi flap remains a foundational and evolving tool in reconstructive surgery, with expanding indications driven by microsurgical and functional innovations. This comprehensive review provides a structured reference to guide surgeons in selecting appropriate LD flap applications tailored to anatomical and functional requirements.
by María García-García, Belén Andresen-Lorca, Alessandro Thione, Pedro Alvedro-Ruiz, Arantxa Blasco-Serra, Eva M. González-Soler, Alfonso A. Valverde-Navarro
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