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. 2023 Jul 1:37:77-81.
doi: 10.1016/j.jpra.2023.06.010. eCollection 2023 Sep.

The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer

Ibrahim Natalwala  1 , Chung Yan Vernon Lee  1 , Simon Kay  1
Affiliations

The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer

Ibrahim Natalwala et al. JPRAS Open. .

Abstract

The latissimus dorsi (LD) muscle is a workhorse flap in reconstructive surgery (e.g., breast reconstruction, chest wall defects, and lower limb trauma). The thoracodorsal artery and its venae comitantes supply this muscle. Recipient vessel options for microsurgical free flap reconstruction of the posterior thorax and lower back are limited. The thoracodorsal vessels are an excellent option due to their reliable anatomy and ease of access. In circumstances when the patient is best positioned prone, the posterior approach to access the thoracodorsal vessels is advantageous. We describe the technique to identify and isolate these vessels via a posterior approach.

Keywords: Microsurgery; Posterior approach; Reconstruction; Technique; Thoracodorsal vessels.

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Conflict of interest statement

All authors do not have any conflict of interest

Figures

Figure 1
Figure 1
View of the right posterior shoulder and scapula with a line marked from the inferior angle of the scapula towards the axilla, denoting the course of the teres major muscle. The skin incision line is placed just below this to coincide with the interval between teres major and latissimus dorsi.
Figure 2
Figure 2
The superior (medial) border of the latissimus dorsi has been released from the teres major muscle.
Figure 3
Figure 3
Gentle retraction of the teres major medially and latissimus dorsi laterally opens up the plane. Beneath can be seen the loose areolar tissue and fat protecting the thoracodorsal vessels.
Figure 4
Figure 4
After releasing the areolar tissue and fat around the vessels, the thoracodorsal artery and its venae comitantes can be seen entering the posterior surface of the latissimus dorsi muscle.
See this image and copyright information in PMC

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