The latissimus dorsi flap moves the broad muscle of the back, sometimes with a patch of overlying skin, around to the chest or arm. It is one of the most versatile flaps in reconstructive surgery and has a famously dependable blood supply.
A latissimus dorsi flap uses the large flat muscle of the back, fed by the thoracodorsal artery, to rebuild tissue elsewhere. Rotated on its pedicle it reaches the breast, chest wall, shoulder and upper arm, and as a free flap it can cover large wounds of the leg. A skin paddle is included when skin is needed too.
Running across the lower back and up into the armpit, the latissimus dorsi is one of the largest flat muscles in the body. It has a single strong artery entering near the armpit, which means the whole muscle can be lifted and swung forwards while staying alive. Surgeons have relied on that arrangement for decades, and it is why this flap turns up in so many different reconstructions.
For the breast it provides soft tissue cover, often alongside an implant, and it is especially useful when chest skin is tight or has been treated with radiotherapy. On the chest wall it fills defects after tumour removal. Around the shoulder and upper arm it restores contour and covers exposed bone. Taken as a free flap and joined to vessels elsewhere, it covers very large wounds of the leg.
Where skin as well as bulk is needed, a paddle of back skin is carried on the muscle. Otherwise the muscle alone is transferred and covered with a split thickness skin graft. The back is closed directly, leaving a long scar that can usually be placed where a bra strap or clothing hides it.
This flap suits reconstructions that need reliable bulk and healthy tissue, particularly where the local skin has already been damaged.
With the patient sitting, the border of the muscle is outlined and any skin paddle is drawn so the resulting scar falls where clothing will hide it. Measurements confirm the flap will reach.
Through an incision on the back the muscle is separated from the skin above and the ribs below. Careful dissection near the armpit protects the artery and vein that keep it alive.
For chest and shoulder work the flap is tunnelled under the skin of the armpit and brought forwards. For distant wounds the vessels are divided and joined to vessels at the recipient site under a microscope.
The muscle is spread and stitched into position to give the contour needed. Where an implant is used in breast reconstruction, it is placed and covered at this point.
Drains are placed at the back and at the reconstructed site, since fluid gathers readily. The back is closed in layers, and dressings support both areas.
Back discomfort is usually the main complaint. Drains remain in place, and gentle arm movements begin under guidance to prevent stiffness.
Drains come out as output falls, though a back drain sometimes stays longer. Sutures are removed and light daily activity resumes.
Shoulder movement is close to normal for most people. Fluid can still gather at the back and may need drawing off in clinic.
Contour settles and scars pale. Strength returns steadily, and physiotherapy continues for those who need full overhead power.
Shape and cover are usually restored well, and the transferred tissue tolerates radiotherapy better than local skin does. Muscle thins over the first year, so some fullness is lost and a small adjustment is occasionally needed. The back scar is long and stays visible for life. Most people regain everyday strength, though heavy overhead and pushing tasks can feel weaker on that side.
The flap itself is reliable, and most problems arise at the back where the muscle was taken.
The back is the donor area and the chest, shoulder or limb is the recipient. Both need looking after, and the back usually needs it for longer.
Neighbouring muscles take over most tasks. Some weakness in pushing and overhead work can remain, and exercises usually restore everyday function.
A space is left where the muscle was, and fluid gathers there in many patients. Drains and clinic aspiration are routine parts of the recovery.
Muscle thins over the first year as it loses its nerve supply, so some settling is expected. Planning allows for it, and small adjustments are possible later.
For the breast, chest wall and shoulder it is rotated on its own vessels. Microsurgery is needed only when it travels to a distant site such as the leg.
Elegance Clinic in Surat plans reconstruction around what each patient needs from the affected limb or chest, and Dr. Ashutosh Shah discusses donor site consequences openly before any decision is made.
This is a technique page, so no price is attached here. The latissimus dorsi flap is a way of rebuilding, and cost depends on the treatment it is used within, whether an implant is added, the length of surgery, anaesthesia and hospital stay.
Indicative bands appear on the relevant treatment pages, and a written estimate is prepared after examination so families can plan before admission.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →No price sits on a technique page. The figure follows the treatment it belongs to, such as breast reconstruction or chest wall repair, and reflects theatre time, any implant, anaesthesia and stay. An estimate is written after examination.
It has a long record and a dependable blood supply. Common issues are fluid gathering at the back, wound healing delays and temporary shoulder stiffness. Risks rise with smoking, obesity and poorly controlled blood sugar.
Drains usually come out within one to two weeks, and light work is often possible at around four weeks. Shoulder strength and stamina build over several months with regular exercises.
Everyday function usually returns, since other muscles compensate. Pushing up from a chair, using crutches and repeated overhead work can feel weaker on that side, which matters more for some occupations than others.
People whose back muscle or its artery was damaged by earlier surgery, those who rely on the muscle for crutches or wheelchair transfers, and those needing a thin, delicate reconstruction are usually offered another method.
It may be done at the same time as tumour surgery or as a delayed procedure months later. Where radiotherapy is planned, timing is agreed with the cancer team so treatment is not held up.
The area to be rebuilt is examined and the back muscle is tested for function and previous scars. Work and sporting demands are discussed, photographs are taken, and options including implants are compared.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
