Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel: A preliminary report

Abstract

The extended latissimus dorsi (LD) flap, which includes adipofascial tissue around the posterior iliac crest, is a good option to reconstruct a large breast. However, poor vascularity in the extended part may cause partial fat necrosis. To minimise this problem, vascular augmentation of the extended adipofascial part was performed. When dissecting under the LD muscle, a single perforator from the 11th intercostal vessels was secured and traced upwards along the rib. After the flap was transferred to the chest, the intercostal vessels were anastomosed to the serratus branches of thoracodorsal vessels. This vascular supercharged extended LD flap technique was applied for selected patients. Intraoperative angiography showed that the contrast medium injected into the intercostal artery spread across the lumbar adipofascial part of the flap. This implies that vascular supercharge through the 11th intercostal vessel promotes the vascularity of the extended LD flap and may help to reduce the flap complication rate.

Key Words::

• Extended LD flap
• vascular augmentation
• intercostal artery