Anatomic studies have shown that the latissimus dorsi muscle has a dual blood supply. The dominant vascular pedicle contains the thoracodorsal artery, the branch of the subscapular artery. The latissimus dorsi muscle and musculocutaneous flap has been elevated based on this cominant vasular pedicle for reconstruction of the breast,head and neck, chest, upper extremity and abdomen,as well as for free tissue transfer.
The latissimus dorsi muscle also receives significant circulation from segmental vessels arising from the thoracic and lumbosacral paraspinous vasculature.
The"reverse" latissimus dorsi muscle and musculocutaneous flap based on these paraspinous perforating vessels has been used for closing difficult wounds of the back in one stage. Anatomical studies by Bostwick and Thomas have shown that the course and location of these vascular pedicles are consistent and predictable, then its versatility and reliability in clinical use was proved previously by several authors.
Two cases of malignant schwannoma and Marjorlin ulcer on the lower back was treated with "reverse" latissimus dorsi muscle flap and split thickness skin graft after wide excision of these lesions,and a case of enterocutaneous fistula on right flank was managed with"reverse" latissimus dorsi musculocutaneous flap after repair of this fistula.
All these flaps were elevated based on the dorsal perforoating branches of the ninth, tenth, and eleventh intercostal vessels following release of the latissimus insertion on the humerus.
Our clinical experience with two "reverse" latissimus dorsi muscle flap and one musculocutaneous flap for coverage of lower back and flank were illustrated. Its results were quite encouraging.
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