Partial Latissimus Dorsi and Rectus Abdominis Muscle Flap Harvest: Preservation of Form and Function at the Donor Site

The latissimus dorsi and rectus abdominis muscles are two of the most reliable and widely applied donor flaps for microvascular reconstruction. Unfortunately, their harvest results in loss of both form and function at the donor sites. These authors presented harvest of the superior portion of the latissimus muscle, partial superior latissimus (PSL) flap, and medial portion of the rectus muscle, partial medial rectus (PMR) flap, a new approach to preserve form and function at the donor sites.

The PMR flap is harvested through a transverse abdominal incision. Intercostal nerves, the superior epigastric artery, as well as branches from the lower intercostals, subcostal, lumbar and deep circumflex arteries to the muscle are left intact. A segment of the medial muscle is harvested based on the deep inferior epigastric artery leaving one-half to two-thirds of the muscle width.

The PSL flap is harvested through a 10–15 cm transverse dorsal thoracic incision overlying the superior aspect of the latissimus muscle. The lateral branch of the thoracodorsal nerve and artery, as well as the deep perforators, are left intact. A segment of the superior muscle is harvested based on the transverse branch of the thoracodorsal neurovascular bundle, leaving at least 70% of the latissimus muscle intact. Follow-up evaluation ranged from 7-10 months.

Ten PSL and 12 PMR flaps were transplanted for microvascular reconstruction of the upper extremity (4 PSL, 5 PMR), lower extremity (5 PSL, 7 PMR), and face (1 PSL). All flaps were successful. There were no hematomas or seromas. PSL muscle volume ranged from 105 cm² to 224 cm². The PMR muscle volume ranged from 18 cm2 to 50 cm2. Pedicle length up to 16 cm for the PSL and 8 cm for the PMR flaps was obtained. No diastasis or hernia were noted after PMR harvest. The lateral thoracic silhouette was symmetric after PSL harvest. Palpable muscle contraction was noted in the residual muscle in all cases. All patients were satisfied with their body contour and scars. No patient complained of decreases in strength or loss of motion.

Partial harvest of the superior latissimus and medial rectus muscles can reliably provide small to moderate tissue volumes for microvascular reconstruction. Partial harvest limits the dissection area and may reduce the risk of seroma and hematoma formation at the donor sites. Maintaining the majority of muscle with its innervation and blood supply preserves both form and function.