An Anatomical Study of the Length of the Neural Pedicle after the Bifurcation of the Thoracodorsal Nerve: Implications for Innervated Free Partial Latissimus Dorsi Flaps

Abstract

The separate neurovascular branches and its minimal pedicle length make the latissimus dorsi muscle very suitable for single functional free muscle transfer, using only the lateral part of the latissimus dorsi muscle, and double functional free muscle transfer using only one vascular pedicle.

Late animation deformity in the denervated pedicled latissimus dorsi flap

“…Our cadaveric results suggest transection of the main branch of thoracodorsal nerve requires dissection to the point of nerve branching at ~2.2 cm proximal to the superior border of the muscle. This is distance is slightly shorter than previously studies by Theewes and Malalasekera . Based on our results, we recommend transecting the thoracodorsal nerve at 39.3 mm proximal to the superior border of the latissimus muscle.…”

“…The incidence of extramuscular branching of the thoracodorsal nerve is poorly reported and highly variable in the literature. The majority of studies investigating thoracodorsal nerve anatomy have been aimed at harvesting the latissimus as an innervated flap . The thoracodorsal nerve arises from roots C6 to C8 and is formed by the posterior divisions of the three brachial plexus trunks; the nerve crosses over teres major to join the thoracodorsal vascular pedicle.…”

Nerves of the Upper Extremity

“…The thoracodorsal nerve divides into two branches upon entering the latissimus dorsi, which separately innervate the medial and lateral portions of the muscle (Bartlett et al 1981;Tobin et al 1981;Theeuwes et al 2011). The thoracodorsal nerve at the neurovascular pedicle to the latissimus dorsi demonstrated a bifurcation (in 94% of 115 specimens), and in a small minority (6% of 115 specimens) where the nerve arborized into three or four branches (Tobin et al 1981).…”

Descripción anatómico-quirúrgica del colgajo dorsoepigástrico: una opción diferente en reconstrucción mamaria

“…El colgajo de músculo dorsal ancho pediculado para reconstrucción mamaria postmastectomia fue descrito por Tansini en 1896 y por D'Este en 1912 (4). Tobin y colaboradores, en 1981, describieron la anatomía neurovascular del musculo dorsal ancho (4)(5)(6). En 1995, Angrigiani y col. describieron el uso de una isla cutánea del dorsal ancho sin el músculo, basado en una perforante de la arteria tóracodorsal para reconstrucción de miembro pélvico (7,8).…”