Latissimus Dorsi Flap

  • Klaus-Dietrich Wolff
  • Frank Hölzle


As the first myocutaneous flap, the latissimus dorsi flap was described already in 1896 by Tansini [523] and used for defect coverage following radical mastectomy by D’Este in 1912 [110]. Despite its excellent suitability for chest wall reconstruction, the flap did not become popular until the 1970s, when a number of publications appeared, in which the previously described advantages were confirmed and further indications for defect coverage in the area of the shoulder and arm were proposed [56, 57, 340, 349, 358, 378, 400, 491]. The first application of a pedicled latissimus dorsi flap for reconstruction in the head and neck area was described by Quillen in 1978 [415], whereas the microvascular transfer of this flap was performed by Watson in 1979 [569]. In further publications, the reliability and safety of this flap, especially its usefulness for reconstructions in the head and neck area, was demonstrated [200, 343, 344, 426, 429, 487, 569]. In all these reports, a great variety of application possibilities was described. This broad indicational spectrum was possible because of the large amount of tissue available, offering various possibilities for changing the flap design, and the long and high-caliber vascular pedicle, making microvascular anastomoses technically easy [380, 426, 429, 433]. A particular indication of the latissimus dorsi flap is the covering of large perforating defects of the oral cavity, using two skin paddles, which can be outlined along the transverse and vertical branch of the thoracodorsal artery [29, 208, 333, 380]. The inclusion of a rib allows for an osteomyocutaneous transfer and was proposed for the reconstruction of the mandible or other parts of the facial skeleton [220, 325, 334]. Another indication of this broad and flat muscle is reconstruction of the scalp, especially when used as a muscle-only flap, which is covered by a skin graft [173, 380, 433, 508], or as a myofascial flap to cover defects at the skull base [428]. Motor reinnervation of the muscle flap has been described by Harii, who connected the thoracodorsal nerve to the facial nerve for rehabilitation of the paralyzed face [198]. For tongue reconstruction, an anastomosis to the hypoglossal nerve was performed [226, 429]. After de-epithelization, musculo-subcutaneous flaps are obtained, which were used for contour augmentations in the head and neck area [130, 380, 429]. Apart from applications in the head and neck area, a lot of other useful indications exist for this very popular free flap, such as reconstructions of the female breast [56, 99, 278], chest wall and axilla [18, 340, 349], shoulder and upper extremity [305, 320], closure of hernias of the diaphragm [38], or other intrathoracic defects [90, 94, 486]. Moreover, defect coverages at the lower extremities [56, 111], the sacrum [453], and treatments of chronic osteomyelitis have been performed using this flap [14, 218].

Supplementary material

Video 6.1

Latissimus dorsi flap (MPG 133994 kb)


  1. 14.
    Anthony JP, Mathes SJ, Alpert BS (1991) The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment. Plast Reconstr Surg 88(2):311–318PubMedGoogle Scholar
  2. 18.
    Arnold PG, Pairolero PC (1984) Chest wall reconstruction. Experience with 100 consecutive patients. Ann Surg 199(6):725–732PubMedPubMedCentralGoogle Scholar
  3. 19.
    Asko-Seljavaara S, Lahteenmaki T, Waris T, Sundell B (1987) Comparison of latissimus dorsi and rectus abdominis free flaps. Br J Plast Surg 40(6):620–628PubMedGoogle Scholar
  4. 30.
    Baker SR (1984) Closure of large orbital-maxillary defects with free latissimus dorsi myocutaneous flaps. Head Neck Surg 6(4):828–835PubMedGoogle Scholar
  5. 33.
    Bartlett SP, May JW Jr, Yaremchuk MJ (1981) The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 67(5):631–636PubMedGoogle Scholar
  6. 34.
    Barton FE Jr, Spicer TE, Byrd HS (1983) Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases. Plast Reconstr Surg 71(2):199–204PubMedGoogle Scholar
  7. 39.
    Bianchi A, Doig CM, Cohen SJ (1983) The reverse latissimus dorsi flap for congenital diaphragmatic hernia repair. J Pediatr Surg 18(5):560–563. doi:S0022346883001025 [pii]Google Scholar
  8. 57.
    Bostwick J 3rd, Nahai F, Wallace JG, Vasconez LO (1979) Sixty latissimus dorsi flaps. Plast Reconstr Surg 63(1):31–41PubMedGoogle Scholar
  9. 58.
    Bostwick J 3rd, Vasconez LO, Jurkiewicz MJ (1978) Breast reconstruction after a radical mastectomy. Plast Reconstr Surg 61(5):682–693PubMedGoogle Scholar
  10. 71.
    Cassel JM (1989) Intramuscular anatomy of the latissimus dorsi muscle. Br J Plast Surg 42(5):607–609PubMedGoogle Scholar
  11. 74.
    Cha W, Jeong WJ, Ahn SH (2013) Latissimus dorsi muscle free flap revisited: a novel endoscope-assisted approach. Laryngoscope 123(3):613–617. doi:10.1002/lary.23757PubMedGoogle Scholar
  12. 91.
    Chicarilli ZN, Ariyan S, Glenn WW, Seashore JH (1985) Management of recalcitrant bronchopleural fistulas with muscle flap obliteration. Plast Reconstr Surg 75(6):882–887PubMedGoogle Scholar
  13. 95.
    Christ JE, Spira M (1982) Application of the latissimus dorsi muscle to the heart. Ann Plast Surg 8(2):118–121PubMedGoogle Scholar
  14. 100.
    Cohen BE, Cronin ED (1984) Breast reconstruction with the latissimus dorsi musculocutaneous flap. Clin Plast Surg 11(2):287–302PubMedGoogle Scholar
  15. 101.
    Coleman JJ 3rd, Sultan MR (1991) The bipedicled osteocutaneous scapula flap: a new subscapular system free flap. Plast Reconstr Surg 87(4):682–692PubMedGoogle Scholar
  16. 111.
    D’Este S (1912) La technique de’l amputation de la mamelle pour carcinome mammarie. Rev Chir (Paris) 45:164Google Scholar
  17. 112.
    Dabb RW, Davis RM (1984) Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation. Plast Reconstr Surg 73(4):633–640PubMedGoogle Scholar
  18. 131.
    Ehrenfeld M (1990) Korrektur subcutaner Weichgewebsdefekte durch mikrochirurgische Transplantate. In: Schuchardt K (ed) Fortschritte der Kiefer- und Gesichtschirurgie, vol XXXV. Thieme, StuttgartGoogle Scholar
  19. 149.
    Fisher J, Bostwick J 3rd, Powell RW (1983) Latissimus dorsi blood supply after thoracodorsal vessel division: the serratus collateral. Plast Reconstr Surg 72(4):502–511PubMedGoogle Scholar
  20. 174.
    Gordon L, Buncke HJ, Alpert BS (1982) Free latissimus dorsi muscle flap with split-thickness skin graft cover: a report of 16 cases. Plast Reconstr Surg 70(2):173–178PubMedGoogle Scholar
  21. 199.
    Harii K (1988) Refined microneurovascular free muscle transplantation for reanimation of paralyzed face. Microsurgery 9(3):169–176PubMedGoogle Scholar
  22. 201.
    Harii K, Ohmori K, Sekiguchi J (1976) The free musculocutaneous flap. Plast Reconstr Surg 57(3):294–303PubMedPubMedCentralGoogle Scholar
  23. 209.
    Hayashi A, Maruyama Y (1989) The “reduced” latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 84(2):290–295PubMedGoogle Scholar
  24. 219.
    Hidalgo DA, Carrasquillo IM (1992) The treatment of lower extremity sarcomas with wide excision, radiotherapy, and free-flap reconstruction. Plast Reconstr Surg 89(1):96–101; discussion 102Google Scholar
  25. 221.
    Hirase Y, Kojima T, Kinoshita Y, Bang HH, Sakaguchi T, Kijima M (1991) Composite reconstruction for chest wall and scalp using multiple ribs-latissimus dorsi osteomyocutaneous flaps as pedicled and free flaps. Plast Reconstr Surg 87(3):555–561PubMedGoogle Scholar
  26. 231.
    Howaldt HP, Bitter K (1990) Totaler Zungenersatz durch ein mikrochirurgisches Latissimus-dorsi-Transplantat. In: Schuchardt K (ed) Fortschritt der Kiefer- und Gesichtschirurgie. Thieme, StuttgartGoogle Scholar
  27. 261.
    Karcher H, Borbely L (1988) Possibilities of vital bone grafts in the maxillofacial area. Dtsch Z Mund Kiefer Gesichtschir 12(2):124–134Google Scholar
  28. 283.
    Kincaid SB (1984) Breast reconstruction: a review. Ann Plast Surg 12(5):431–448PubMedGoogle Scholar
  29. 302.
    Krishna BV, Green MF (1980) Extended role of latissimus dorsi myocutaneous flap in reconstruction of the neck. Br J Plast Surg 33(2):233–236. doi:0007-1226(80)90018-1 [pii]Google Scholar
  30. 309.
    Laitung JK, Peck F (1985) Shoulder function following the loss of the latissimus dorsi muscle. Br J Plast Surg 38(3):375–379PubMedGoogle Scholar
  31. 311.
    Landra AP (1979) The latissimus dorsi musculocutaneous flap used to resurface a defect on the upper arm and restore extension to the elbow. Br J Plast Surg 32(4):275–277PubMedGoogle Scholar
  32. 322.
    Logan AM, Black MJ (1985) Injury to the brachial plexus resulting from shoulder positioning during latissimus dorsi flap pedicle dissection. Br J Plast Surg 38(3):380–382PubMedGoogle Scholar
  33. 328.
    MacKinnon SE, Weiland AJ, Godina M (1983) Immediate forearm reconstruction with a functional latissimus dorsi island pedicle myocutaneous flap. Plast Reconstr Surg 71(5):706–710PubMedGoogle Scholar
  34. 333.
    Manktelow RT (1986) Microvascular reconstruction. Springer, BerlinGoogle Scholar
  35. 341.
    Maruyama Y, Iwahira Y, Hashimura C, Ono H (1986) One stage total cheek reconstruction with double folded extended latissimus dorsi musculocutaneous flap. Acta Chir Plast 28(3):159–166PubMedGoogle Scholar
  36. 342.
    Maruyama Y, Urita Y, Ohnishi K (1985) Rib-latissimus dorsi osteomyocutaneous flap in reconstruction of a mandibular defect. Br J Plast Surg 38(2):234–237PubMedGoogle Scholar
  37. 348.
    Mathes SJ, Nahai F (1982) Clinical applications for muscle and myocutaneous flaps. C. V. Mosby, St. LouisGoogle Scholar
  38. 351.
    Maxwell GP, Manson PN, Hoopes JE (1979) Experience with thirteen latissimus dorsi myocutaneous free flaps. Plast Reconstr Surg 64(1):1–8PubMedGoogle Scholar
  39. 352.
    Maxwell GP, Stueber K, Hoopes JE (1978) A free latissimus dorsi myocutaneous flap: case report. Plast Reconstr Surg 62(3):462–466PubMedGoogle Scholar
  40. 357.
    McCraw JB, Penix JO, Baker JW (1978) Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast Reconstr Surg 62(2):197–206PubMedGoogle Scholar
  41. 366.
    Mendelson BC, Masson JK (1977) Treatment of chronic radiation injury over the shoulder with a latissimus dorsi myocutaneous flap. Plast Reconstr Surg 60(5):681–691PubMedGoogle Scholar
  42. 387.
    Muhlbauer W, Olbrisch RR (1977) The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plast 4(1):27–34Google Scholar
  43. 389.
    Mühling J, Reuther J (1990) Indikationen zum Transfer des Latissimus-dorsi-Myokutanlappens zur Rekonstruktion im Kopf-Hals-Bereich. In: Schuchardt K (ed) Fortschritte in der Kiefer- und Gesichtschirurgie, vol XXXV. Thieme, StuttgartGoogle Scholar
  44. 406.
    O’Brien B, Morrison WA (1987) Reconstructive microsurgery. Churchill, LivingstonGoogle Scholar
  45. 408.
    Olivari N (1976) The latissimus flap. Br J Plast Surg 29(2):126–128PubMedGoogle Scholar
  46. 423.
    Quillen CG (1979) Latissimus dorsi myocutaneous flaps in head and neck reconstruction. Plast Reconstr Surg 63(5):664–670PubMedGoogle Scholar
  47. 424.
    Quillen CG, Shearin JC Jr, Georgiade NG (1978) Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area: case report. Plast Reconstr Surg 62(1):113–117PubMedGoogle Scholar
  48. 435.
    Riediger D (1983) Mikrochirurgische Weichgewebstransplantate in die Gesichtsregion. Hanser, MünchenGoogle Scholar
  49. 437.
    Riediger D, Ehrenfeld M (1990) Mikrochirurgischer Weichgewebstransfer in die Mund-Kiefer-Gesichtsregion. In: Schuchardt K (ed) Fortschritte in der Kiefer- und Gesichtschirurgie, vol XXXV. Thieme, StuttgartGoogle Scholar
  50. 438.
    Riediger D, Schmelzle R (1986) Modified use of the myocutaneous latissimus dorsi flap for repairing defects in the oral and maxillofacial region. Dtsch Z Mund Kiefer Gesichtschir 10(5):364–374PubMedGoogle Scholar
  51. 442.
    Robson MC, Zachary LS, Schmidt DR, Faibisoff B, Hekmatpanah J (1989) Reconstruction of large cranial defects in the presence of heavy radiation damage and infection utilizing tissue transferred by microvascular anastomoses. Plast Reconstr Surg 83(3):438–442PubMedGoogle Scholar
  52. 448.
    Rowsell AR, Davies DM, Eisenberg N, Taylor GI (1984) The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections. Br J Plast Surg 37(4):574–576PubMedGoogle Scholar
  53. 449.
    Rowsell AR, Eisenberg N, Davies DM, Taylor GI (1986) The anatomy of the thoracodorsal artery within the latissimus dorsi muscle. Br J Plast Surg 39(2):206–209PubMedGoogle Scholar
  54. 450.
    Rowsell AR, Godfrey AM, Richards MA (1986) The thinned latissimus dorsi free flap: a case report. Br J Plast Surg 39(2):210–212PubMedGoogle Scholar
  55. 453.
    Russell RC, Pribaz J, Zook EG, Leighton WD, Eriksson E, Smith CJ (1986) Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg 78(3):336–344PubMedGoogle Scholar
  56. 457.
    Sadove RC, Sengezer M, McRoberts JW, Wells MD (1993) One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg 92(7):1314–1323; discussion 1324–1315Google Scholar
  57. 462.
    Salibian AH, Tesoro VR, Wood DL (1983) Staged transfer of a free microvascular latissimus dorsi myocutaneous flap using saphenous vein grafts. Plast Reconstr Surg 71(4):543–547PubMedGoogle Scholar
  58. 469.
    Satoh K, Ohkubo F, Tojima Y (1991) A variation of the vascular pedicle of the latissimus dorsi muscle. Plast Reconstr Surg 88(6):1081–1084PubMedGoogle Scholar
  59. 486.
    Seitz A, Papp S, Papp C, Maurer H (1999) The anatomy of the angular branch of the thoracodorsal artery. Cells Tissues Organs 164(4):227–236. doi:cto64227 [pii]Google Scholar
  60. 495.
    Shesol BF, Clarke JS (1980) Intrathoracic application of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 66(6):842–845PubMedGoogle Scholar
  61. 496.
    Shestak KC, Schusterman MA, Jones NF, Johnson JT (1988) Immediate microvascular reconstruction of combined palatal and midfacial defects using soft tissue only. Microsurgery 9(2):128–131PubMedGoogle Scholar
  62. 500.
    Silverton JS, Nahai F, Jurkiewicz MJ (1978) The latissimus dorsi myocutaneous flap to replace a defect on the upper arm. Br J Plast Surg 31(1):29–31PubMedGoogle Scholar
  63. 517.
    Stranc MF, Globerman DY (1989) Accidental reinnervation as a complication of latissimus dorsi free flap to the face and scalp. Br J Plast Surg 42(3):341–343PubMedGoogle Scholar
  64. 532.
    Tansini I (1896) Nuovo processo per I’ amputazione della mammaella per cancere. Riforma Med 12:3Google Scholar
  65. 546.
    Tobin GR, Schusterman M, Peterson GH, Nichols G, Bland KI (1981) The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap. Plast Reconstr Surg 67(5):637–641PubMedGoogle Scholar
  66. 559.
    Urken ML, Cheney ML, Sullivan MJ, Biller HF (1990) Atlas of regional and free flaps for head and neck reconstruction. Raven Press, New YorkGoogle Scholar
  67. 578.
    Watson JS, Craig RD, Orton CI (1979) The free latissimus dorsi myocutaneous flap. Plast Reconstr Surg 64(3):299–305PubMedGoogle Scholar
  68. 636.
    Zhou Y, Chen L, Hu S, Gu Y (2002) Brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap. Chin J Traumatol 5(4):254–256PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Klaus-Dietrich Wolff
    • 1
  • Frank Hölzle
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryKlinikum rechts der Isar, Technische Universität MunichMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital of RWTH Aachen UniversityAachenGermany

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