The Axillary Approach to Raising the Latissimus Dorsi Free Flap for Facial Re-Animation: A Descriptive Surgical Technique

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

Keywords

Facial palsy - Facial reanimation - Free flap - Latissimus dorsi

Publication History

Received: 15 May 2014

Accepted: 23 June 2014

Article published online:
05 May 2022

• References

• 1 Tansini I. Nuovo processo per l'amputazione della mammaella per cancere. Riforma Med 1896; 12: 3-5
• 2 D'Este S. La technique de l'amputation de la mamell pour carcinome mamaire. Rev Chirug (Paris) 1912; 45: 164-210
• 3 Watson JS, Craig RD, Orton CI. The free latissimus dorsi myocutaneous flap. Plast Reconstr Surg 1979; 64: 299-305
• 4 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57: 133-143
• 5 Harrison DH. The pectoralis minor vascularized muscle graft for the treatment of unilateral facial palsy. Plast Reconstr Surg 1985; 75: 206-216
• 6 Zuker RM, Goldberg CS, Manktelow RT. Facial animation in children with Mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg 2000; 106: 1-8
• 7 Mackinnon SE, Dellon AL. Technical considerations of the latissimus dorsi muscle flap: a segmentally innervated muscle transfer for facial reanimation. Microsurgery 1988; 9: 36-45
• 8 Cassel JM. Intramuscular anatomy of the latissimus dorsi muscle. Br J Plast Surg 1989; 42: 607-609
• 9 Harii K, Asato H, Yoshimura K. et al. One-stage transfer of the latissimus dorsi muscle for reanimation of a paralyzed face: a new alternative. Plast Reconstr Surg 1998; 102: 941-951
• 10 Zhou Y, Chen L, Hu S. et al. Brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap. Chin J Traumatol 2002; 5: 254-256
• 11 Ramirez OM, Daniel RK. Endoscopic plastic surgery. New York: Springer; 1996
• 12 Ferguson LD, Paterson T, Ramsay F. et al. Applied anatomy of the latissimus dorsi free flap for refinement in one-stage facial reanimation. J Plast Reconstr Aesthet Surg 2011; 64: 1417-1423
• 13 Watanabe K, Kiyokawa K, Rikimaru H. et al. Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg 2010; 63: 1091-1098
• 14 Bove A, Chiarini S, D'Andrea V. et al. Facial nerve palsy: which flap? Microsurgical, anatomical, and functional considerations. Microsurgery 1998; 18: 286-289
• 15 Bostwick J, Eaves FF, Nahai F. Endoscopic plastic surgery. St. Louis, Mo: Quality Medical; 1995