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Résumé Le lambeau de grand dorsal (Latissimus Dorsi ou LD) a été décrit pour la première fois par l'Italien Tansini en 1896 et publié en 1906 dans le cas d'une reconstruction de la paroi thoracique après amputation mammaire. L'utilisation du lambeau de grand dorsal dans toutes ses variantes est très fréquente en reconstruction mammaire. Dans ces indications, le muscle est prélevé pour permettre de vasculariser la palette cutanée et/ou apporter du volume au sein reconstruit. Lorsque le muscle est prélevé en totalité ou presque, sa fonction motrice est alors totalement perdue. Les séquelles fonctionnelles liées à la perte du muscle grand dorsal sont alors définitives. Tobin et al. ont montré que le muscle grand dorsal pouvait être séparé en deux lambeaux basés sur les divisions de l'artère thoracodorsale ; le concept d'épargne musculaire était alors posé (Muscle-Sparing Latissimus Dorsi [MSLD]). Le lambeau dorsal avec conservation du muscle (MSLD) tel que nous le prélevons n'emporte qu'une fine bandelette musculaire et préserve 95 % du muscle grand dorsal avec sa vascularisation et son innervation motrice. Cette technique est de levée rapide avec une morbidité du site donneur très faible. Les séquelles fonctionnelles et les complications postopératoires apparaissent limitées par rapport au prélèvement d'un grand dorsal complet quelle que soit la cicatrice dorsale. Le volume du sein à reconstruire est obtenu par plusieurs séances de greffe de tissu adipeux. Nous présentons ici les bases anatomiques et la technique chirurgicale du lambeau dorsal avec conservation du muscle grand dorsal associé à un lambeau thoraco-abdominal d'avancement et une greffe de tissu adipeux en reconstruction mammaire. Summary The Latissimus Dorsi flap (or LD flap) was first described by the Tansini in 1896 and published in 1906. It concerned a case of chest wall reconstruction after breast amputation. The use of the LD flap in all its variants is very frequent in breast reconstruction. In these indications, the muscle is harvested for skin paddle vascularization and/or for bringing volume to the reconstructed breast. When all or most of the muscle is taken, its motor function is completely lost. The functional sequelae due to the loss of the latissimus dorsi muscle are then definitive. Tobin et al. showed that the LD muscle can be separated into two flaps based on the division of the thoracodorsal artery; the concept of muscle-sparing was then posed (Muscle-Sparing Latissimus Dorsi [MSLD]). The MSLD as we perform now, concerns only a thin muscle strip and preserves 95% of the LD muscle with its vascularization and motor innervation. This technique is quick with very low donor site morbidity. The functional sequelae and postoperative complications appear limited compared to the harvest of a total LD whatever the posterior scar. The volume of the breast to be reconstructed is obtained by several sessions of fat grafting. We present here the anatomical bases and the surgical technique of the muscle-sparing latissimus dorsi associated with a thoracoabdominal advancement flap and fat grafting in breast reconstruction. [ABSTRACT FROM AUTHOR]

Résumé Le lambeau de grand dorsal autologue ou lambeau de grand dorsal sans prothèse est la technique la plus récente et la technique qui a le plus profité des progrès au cours de ces dernières années. La technique chirurgicale est bien codifiée et permet de prélever les différentes zones graisseuses adjacentes au muscle grand dorsal, pour permettre une reconstruction autologue. La vascularisation du lambeau est fiable, grâce au pédicule thoracodorsal, ce qui permet l'utilisation de ce lambeau dans de nombreuses indications, y compris dans les cas de contre-indications au TRAM et au DIEP. Le lipomodelage du décolleté, dès le temps initial, permet de restaurer le décolleté. Puis deux mois plus tard, le lipomodelage de l'ensemble du sein reconstruit permet d'obtenir le volume souhaité pour le sein reconstruit. Suivant les cas, une ou deux séances de lipomodelage sont nécessaires pour obtenir le résultat escompté. Les avantages de ce lambeau sont sa fiabilité, sa sécurité, sa trophicité et le très faible taux de complications. Les inconvénients sont actuellement très faibles, une fois que la courbe d'apprentissage a été faite, puisque le principal inconvénient de cette technique était la survenue d'un sérome dorsal, et que cet inconvénient a été réduit de façon majeure depuis l'utilisation de la technique du capitonnage dorsal au fil cranté. Finalement, la reconstruction par lambeau de grand dorsal autologue s'est imposée dans notre équipe comme la meilleure technique de reconstruction mammaire autologue, et a actuellement supplanté les techniques utilisant le lambeau abdominal, que ce soit le TRAM flap et le DIEP. Summary Amongst various techniques of breast reconstruction, Autologous Latissimus Dorsi (ALD) flap without breast implant is the newest technique that took advantage of recent improvement during the last decade. Surgical procedure is well standardized, and allows to harvest various fat areas attached to the muscle, to obtain an autologous reconstruction. Thoracodorsal pedicle is steady and makes ALD the most reliable flap that can be used in several indications, especially when DIEP or TRAM flap are inappropriate. Lipomodeling of the cleavage is performed during the first surgery. Additionnal lipomodeling is performed in the whole reconstructed breast area at 2 months to get the expected volume. In some cases, two lipomodelings may be required. Advantages of ALD flap are numerous such as its reliability, its trophicity, and a very low complications rate. After a learning curve, drawbacks are well controlled, since quilting suture of the donor site helped to reduce drastically seroma rate. Finally, ALD flap became the best technique, and the most used in our team for autologous breast reconstruction, and surpassed abdominal flaps such as TRAM flap or DIEP flap. [ABSTRACT FROM AUTHOR]

Résumé Malgré l'essor de la microchirurgie, la reconstruction mammaire par lambeau musculo-cutané de grand dorsal pédiculé reste une intervention très pratiquée. Elle est fiable, réalisable chez la quasi-totalité des patientes, sans contre-indication chez les fumeuses et est indiquée après radiothérapie. La variante technique qui combine le lambeau de grand dorsal et un implant, permet de reconstruire le volume mammaire désiré et favorise l'augmentation prothétique controlatérale si la patiente le souhaite. La palette dorsale augmente la poche cutanée, le muscle étoffe en profondeur la peau irradiée et protège la prothèse. Un positionnement précis de la palette cutanée en zone mammaire, soit dans la cicatrice de mastectomie, soit dans une contre-incision à part, permet un apport cutané dans le pôle inféro-externe du sein le plus galbé et permet au muscle d'englober la prothèse à la manière d'un soutien-gorge. Ces repères précis de positionnement du lambeau sont reproductibles et assurent un résultat d'emblée harmonieux et stable dans le temps. Summary Despite the development of microsurgical techniques, latissimus dorsi myocutaneous pedicle flap remains mainly used in breast reconstruction surgery. It is reliable and could be performed on almost all the patients, even if they smoke. It is also a good indication in case of irradiation. The technical alternative, which combines latissimus dorsi myocutaneous flap and an implant, allows the reconstruction of the expected volume and enables controlateral implant augmentation if the patient desires. The dorsal skin paddle increases the cutaneous pocket. The muscle in-depth enhances the irradiated skin and protects the implant. Positioning the skin paddle on the breast area is essential: it should be based on the mastectomy scar or on an added contraincision barring it. Thus it allows the muscle to embrace the implant as a bra. The precise reference points helping the placement of the flap could be reproduced and ensure pleasant and stable results over time. [ABSTRACT FROM AUTHOR]

Résumé Introduction Ces dernières années, le lambeau de grand dorsal a vu ses indications se réduire au profit de sa version préservant le muscle : le lambeau perforant thoracodorsal (TDAP). La dissection intramusculaire de la perforante permet de diminuer les séquelles au niveau du site donneur mais permet également un allongement du pédicule par rapport au pédicule du lambeau musculocutané de grand dorsal. Le but de cette étude était de quantifier de manière objective l’allongement du pédicule thoracodorsal lorsque la perforante est disséquée au travers des fibres musculaires et au sein du tissus adipeux sous-cutané. Matériels et méthodes Seize TDAP ont été disséqués sur cadavre frais. Nous avons défini 4 portions de pédicule : (1) hypoderme ; (2) tissu adipeux sous-cutané ; (3) tissu intramusculaire ; (4) pédicule « classique ». La longueur de chaque portion et la longueur totale du pédicule ont été mesurées. Résultats La dissection intramusculaire de la perforante permet d’obtenir un allongement du pédicule théorique de 5,25 cm, voire de 9,19 cm si l’on poursuit la dissection dans le tissu sous-cutané. La longueur totale potentiellement exploitable est de 20,66 cm. Conclusion La dissection de la perforante du lambeau thoracodorsal permet d’obtenir un allongement du pédicule d’environ 5 cm, voire de 9 cm si l’on pousse la dissection dans le tissu sous-cutané. Un long pédicule présente un intérêt en chirurgie reconstructrice des membres et en reconstruction faciale lorsque la microchirurgie n’est pas réalisable. Summary Purpose In recent years, the indications of latissimus dorsi myocutaneous flap decreased in favor of its version preserving muscle: the thoracodorsal artery perforator flap (TDAP). The intramuscular dissection reduce donor site morbidity but also allows an extension of the pedicle compared to conventional latissimus dorsi flap pedicle. The purpose of this study was to quantify objectively elongation of the pedicle when the perforator is dissected through the muscle. Method Sixteen TDAP flap were dissected in 9 cadavers. The pedicle was divided into 4 distinct parts: (1) hypodermis, (2) subcutaneous fat, (3) intramuscular, (4) conventional pedicle. Results The length of the pedicle is significantly increased when the pedicle is dissected through the muscle. This extends the theoretical length from 5.25 cm up to 9.19 cm if the dissection is extended to the deep fat. Indeed, this results in a potentially exploitable TDAP pedicle length of 20.66 cm. Conclusion The dissection of the perforator allows an extension of the pedicle of about 5 or 9 cm if we continue the dissection in the subcutaneous fat. A long pedicle may be interesting in lower limb reconstructive surgery and facial reconstruction where microsurgery is not feasible. [ABSTRACT FROM AUTHOR]

Résumé La position de la palette cutanée sur l’aire mammaire est un élément fondamental pour les reconstructions par grand dorsal avec prothèse. Faut-il comme Millard, recréer le défaut initial et l’inclure dans la cicatrice de mastectomie ou est-il préférable de contre-inciser à distance comme le présentent les autres auteurs. Cette étude compare les résultats morphologiques à long terme de ces deux attitudes, avec ou sans contre-incision. Patients et méthodes Quatre-vingt-deux reconstructions mammaires par grand dorsal avec prothèse sont revues à distance (recul moyen : 9,5 ans) et cotées de 1 à 5 par un panel expert et non-expert. Les patientes ont noté aussi leur propre reconstruction. Différents paramètres du sein reconstruit ont été ainsi évalués. On comparait les résultats, selon le positionnement de la palette cutanée : avec contre-incision (50 cas) ; sans contre-incision (32 cas). Les caractéristiques de la cicatrice de mastectomie sur l’aire mammaire, haute ou basse, horizontale ou oblique, définissaient 6 groupes où étaient comparés les résultats des deux options chirurgicales. Résultats Seules les reconstructions avec contre-incision obtiennent des résultats significativement supérieurs à ceux sans contre-incision ( p < 0,05). Ils concernent les deux panels, pour les cicatrices de mastectomies hautes. En revanche, pour les cicatrices basses horizontales ou obliques, la contre-incision ne s’impose pas. Conclusions Si la réalisation d’une incision supplémentaire peut être perçue comme inadaptée sur une région déjà « mutilée », nous plaidons pour cette solution dans des cas sélectionnés. Ceci apporte un bénéfice objectivé et stable dans le temps, en termes de résultat global, de forme et même de rendu cicatriciel. Summary The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision. Patients and methods Eighty-two breast reconstructions by latissimus dorsi flap and prosthesis implantation, with a mean follow-up of 9.5 years were scored from 1 to 5 by a panel of expert and non-expert. The patients scored also their own reconstruction. Various parameters of the reconstructed breast were thus evaluated. We compared the results, according to the positioning of the skin paddle: with additional incision (50 cases); without additional incision (32 cases). The characteristics of the mastectomy scar on the breast area, high or low, horizontal or oblique, defined 6 groups where the results of the 2 surgical options were compared. Results Only the reconstructions with additional incision get significantly higher results than those without additional incision ( P < 0.05). This involves the two panels, in the case of high mastectomy scars. In the others cases the additional incision is not essential. Conclusions If the realization of an additional incision can be perceived like misfit on an area already “mutilated”, we plead for this solution in selected cases. This provides a benefit stable in time, in terms of overall results, shape and even rendering scar. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Le nombre de reconstruction mammaire immédiate (RMI) après mastectomie est en augmentation, et dans ce contexte nous avons cherché à évaluer la tolérance du lambeau de grand dorsal sans prothèse à la radiothérapie adjuvante. Matériel et méthodes De janvier 1999 à août 2013, nous avons opéré 31 patientes consécutives par mastectomie avec RMI par lambeau de grand dorsal, suivie d’une radiothérapie adjuvante du sein reconstruit. Les patientes ont été sélectionnées à partir d’une base de données prospective et recontactées pour évaluer les résultats esthétiques à distance. Deux patientes ont été perdues de vue. Résultats La médiane de suivi est de 6,5 années. Les résultats esthétiques de la reconstruction ont été évalués comme bons ou très bons dans 86 % des cas, avec une consistance du sein irradiée évaluée comme bonne ou très bonne dans 93 % des cas. Un transfert graisseux de complément a été réalisé en moyenne 11 mois après la radiothérapie dans 58 % des cas, avec un volume moyen transféré de 250 cc. Une symétrisation du sein controlatéral était associée dans le même temps opératoire pour 32 % de la population totale. La RMI était évalué a posteriori par les patientes comme indispensable dans 79 % des cas. Conclusion Dans notre expérience, la tolérance du lambeau de grand dorsal à un traitement adjuvant par radiothérapie est bonne. Cette méthode peut être proposée aux patientes demandeuses d’une RMI malgré une irradiation postopératoire attendue. Summary Objectives Rates of immediate breast reconstruction (IBR) after mastectomy are currently increasing, leading us to evaluate outcomes of breast reconstruction with latissimus dorsi without implant followed by adjuvant radiotherapy. Materials and methods From January 1999 to August 2013, 31 breast reconstructions with latissimus dorsi have been irradiated. Patients have been selected from a prospective database and contacted to evaluate outcomes of breast reconstruction, and 2 patients have been lost. Results Median follow-up was 6.5 years. Breast reconstruction outcomes were evaluated as very good or good in 86% of cases, with breast reconstructed consistency as very good or good in 93% of cases. An additional fat grafting has been performed for 58% of cases (mean volume transferred of 250 cc) and was associated with contralateral breast reduction in 32% of the whole population. IBR was judged as essential for 79% of women a posteriori. Conclusion In our experience, latissimus dorsi has a good tolerance to adjuvant irradiation, and may be offered to patients willing to benefit of an IBR even if postoperative radiotherapy is scheduled. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude La reconstruction mammaire par lambeau de grand dorsal et lipofilling est une technique très utilisée en pratique courante. Certains opérateurs lui reprochent néanmoins l’absence de résultat définitif lors de la première intervention, et la nécessité de séances répétées de lipofilling. L’objectif de cette étude était de comparer le nombre de réinterventions chez les patientes ayant bénéficié d’une reconstruction par grand dorsal sans prothèse versus avec prothèse. Patients et méthodes Nous avons inclus les patientes opérées d’une reconstruction mammaire par lambeau de grand dorsal avec ou sans prothèse entre 2008 et 2012 dans notre centre. Nous avons relevé le nombre de nouvelles interventions chirurgicales chez ces patientes, qu’il s’agisse de lipofilling ou de reprise liée à l’implant. Nous avons également noté le poids moyen de la mastectomie dans les deux groupes sur chaque année. Résultats Cent quatre-vingt-six patientes ont été incluses dans cette étude. Quatre-vingt-onze patientes ont bénéficié d’une reconstruction par grand dorsal et prothèse, et 95 patientes d’une reconstruction par grand dorsal et greffe adipocytaire. Il n’a pas été mis en évidence de différence significative concernant le nombre d’interventions supplémentaires entre les deux groupes. Le poids moyen des mastectomies dans le groupe autologue n’a cessé d’augmenter sur les cinq ans. Il n’existait pas de différence significative concernant le poids moyen des mastectomies entre les deux groupes sur les deux dernières années. Conclusion L’évolution des indications dans notre centre s’est faite vers l’absence d’implantation prothétique en cas de reconstruction mammaire par grand dorsal, quel que soit le volume du sein. Summary Aim of the study Breast reconstruction with latissimus dorsi flap and fat grafting is a technique widely used in current practice. Some operators still complain at the lack of final results at the first intervention and the need for repeated lipofilling sessions. The objective of this study was to compare the number of reoperations in patients who underwent reconstruction with latissimus dorsi with prosthesis versus without prosthesis. Patients and methods We included all patients operated for breast reconstruction with latissimus dorsi flap, with or without prosthesis between 2008 and 2012 in our center. We noted the number of new surgical interventions in these patients on the reconstructed breast. We also noted the average weight of mastectomy in two groups each year. Results One hundred and eighty-six patients were included in this study. Ninety-one patients underwent reconstruction with latissimus dorsi and prosthesis, and 95 patients reconstruction by latissimus dorsi and fat graft. It has not been demonstrated significant differences in the number of new surgical procedures between the two groups. The average weight of mastectomies in the autologous group has steadily increased over the five years. There was no significant difference in the average weight of mastectomies between the two groups over the last two years. Conclusion For breast reconstruction with latissimus dorsi flap, surgical indications changed in our center to the absence of prosthetic implant, whatever the volume of the breast. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The aim of this study is to assess our results of autologous breast reconstruction using a combined muscle sparing latissimus dorsi flap (MSLD) and fat tissue transfer. Methods: A prospective study was performed on 20 patients over a period of 1 year. Three objective criteria were analyzed: morphometric, surgical procedure and postoperative latissimus dorsi function. A subjective assessment was done using a 4-level scale for patients’ and surgeons’ satisfaction. Results: Mean age of patients was of 45±1.2 years. The average Body Mass Index (BMI) was 21.9±2.2. The average weight of mastectomy specimen was 348.3±135.6 g. The average duration of the surgical procedure was 149±32.1minutes. The average length of hospitalization was 4.5±1.4 days. The average quantity of dorsal drainage during the hospitalization was 117.7±41.5 cm3, and a Visual Analog Scale (VAS) of pain of 2±0.9 over 10. Patients from our series had 0.8±0.9 dorsal punction per patient, with an average volume of seroma of 51.2±70.8 cm3. Fat grafting was used in every case with an average number of 1.2±0.4 procedures per patient. The mean of injected volume was 250.1±132.8 cm3. No complications occurred in the postoperative period. There was no difference of latissimus dorsi functional assessment at 3 months and 1 year postoperative. Conclusion: Combined MSLD and fat transfer is a reliable and an efficient technique for autologous breast reconstruction. The donor site morbidity is low, the postoperative recovery is fast and functional integrity of latissimus dorsi muscle is preserved in all cases. This technique can be used in immediate or delayed autologous breast reconstruction, and is particularly useful for bilateral breast reconstruction. [ABSTRACT FROM AUTHOR]

Summary: By offering a new concept in tissue defect management, perforator flaps reduce morbidity of the donor site. The thoracodorsal perforator flap allows the harvesting of a cutaneous flap that can reach 15×25cm, by sparing the underlying muscle. Moreover, the postoperative strength of the latissimus dorsi does not seem to be affected and seroma is less frequent. We review the anatomical basis and the operative technique of this flap. For us, this flap is more suitable than its muscular homologous in several indications. [Copyright &y& Elsevier]

Summary: The use of combined flap involving the distally based latissimus dorsi muscle pedicled on the lumber perforating arteries and prolonged by the last digitations of the serratus anterior flap muscle supplied by the thoracic branch of thoracodorsal vessels is uncommon but has ever been described. We describe the use of this flap in two original cases. The first case is for coverage of a controlateral dorsal radionecrosis. The second case describes its use in emergency following ballistic chest trauma. [Copyright &y& Elsevier]

Summary: Background: The muscle-sparing latissimus dorsi flap pedicled on descending branch presents distinct advantages in breast reconstruction, specially when there is a transversely oriented skin paddle, including reduced donor site morbidity, sparing muscle function and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, advantages and complications of this technique. Four clinical cases illustrate surgical indications in breast reconstructive surgery. Methods: An anatomical cadaveric study underwent to University of Texas Southwestern Medical Center, Dallas. The goal was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch compare to the anterior side of latissimus dorsi muscle. Four clinical cases illustrated indications of muscle-sparing latissimus dorsi flap pedicled on descending branch in breast reconstruction. These cases showed advantages and complications of the technique, and impact on donor site. Results: Fifteen descending branch muscle-sparing latissimus dorsi flaps were harvested. All flaps had a bifurcation of the thoracodorsal artery. The average was located at 5,1cm from posterior axillary side (from 2,1 to 7,5cm) and average of 2,2cm from the anterior side of latissimus dorsi muscle (from 1,3 to 3,1cm). To 5, 10 and 15cm from posterior axillary side, the descending branch was located at respectively an average of 2,0cm (from 1,4 to 2,5), 2,4cm (from 1,3 to 3,3), and 2,9cm (from 2,0 to 3,8) behind the anterior side of latissimus dorsi muscle. The average length of descending branch was measured at 15,2cm (from 13,2 to 19,0). None clinical cases paddle suffering was observed. Donor site morbidity was less than classical or extended adipomuscular technique. Latissimus dorsi muscle function is spared. Conclusions: The muscle-sparing latissimus dorsi flap, pedicled on descending branch, is versatile and reproducible. It results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar. There are a lot of indications in breast reconstruction. [Copyright &y& Elsevier]

Summary: Reconstruction of a large dorsal radionecrosis with bilateral latissimus dorsi V-Y musculocutaneous flaps is reported. This procedure provides a reliable, well-vascularized soft-tissue coverage. Geometric analysis and differences between V-Y advancement flap and V-Y rotation flap are discussed. [Copyright &y& Elsevier]

Summary: The latissimus dorsi musculocutaneous flap has been widely used for breast reconstruction. It is a reliable method with low complications. Thoracodorsal pedicle is constant but might have been dissected and injured previously, for example, in case of axillary lymph node dissection. The purpose of our study is to assess the benefit of systematic preoperative echo-doppler imaging of the thoracodorsal pedicle. Seventy-four consecutive patients with unilateral axillary lymph node dissection undergoing latissimus dorsi flap underwent doppler and color duplex sonography of the thoracodorsal pedicle preoperatively. Non operated and contralateral pedicle served as reference. A total of 12.2% patients had differences between operated and non operated pedicle, 9.5% had smaller operated pedicle and 2.7% patients had stenosis with altered blood flow. Stenosis of the pedicle contraindicates, in our unit, latissimus dorsi flap because of altered blood flow. There were no flap necrosis in our serie. The percentage of stenosed pedicle in our serie is similar to percentage of flap necrosis in the literature. We think that systematic doppler and color duplex sonography of the thoracodorsal pedicle increase the reliability of latissimus dorsi flap by excluding pedicle with altered blood flow. [Copyright &y& Elsevier]

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Abstract: Purpose.– The latissimus dorsi flap based on the secondary segmental vessels, wich is termed « reverse » or « distally based » latissimus dorsi flap, has been used to repair major thoraco-lumbar defects, to close myelomeningoceles and to reconstruct congenital diaphragmatic absences. The arc of flap rotation is markedly restricted because the blood supply is segmental. It is the most important factor that limits the flap mobility and so restricts its use. The authors report an anatomic study of these secondary pedicles in order to improve the flap dissection and to extend the arc of flap rotation. Material and method.– The precise location of the secondary pedicles of the flap was determined by 24 anatomic dissections. Results.– The latissimus dorsi has 3, 4 or 5 secondary pedicles respectively in 50%, 25% and 25% of cases in the study. These pedicles take origin from the dorsal branches of the posterior intercostal arteries of the 7th, 8th, 9th, 10th and 11th intercostal spaces. Conclusion.– The number of secondary pedicles is not constant. The entire flap can be safely based on 2 secondary pedicles when the latissimus dorsi muscle has 3 secondary pedicles. When this muscle has 4 or 5 secondary pedicles, the entire flap should be at least based on 3 secondary pedicles, particularly if the skin island is very far from the origin of these vessels. [Copyright &y& Elsevier]

Thigh loss cover after carcinologic resection of sarcomas can be complex and compromise the vascular tree of the lower limb. We report a case of a patient with recurrent sarcoma of the right thigh. After multiple resections, the femur and hip joint are exposed. The superficial and deep femoral vessels are taken in the excisional piece. The reconstruction is performed by a free musculocutaneous latissimus dorsi flap, anastomosed to the deep inferior controlateral epigastric vessels. The deep inferior epigastric vessels are of sufficient length to join the contralateral hemiabdomen after dissection with a gauge allowing microsurgical anastomoses. They can serve as recipient vessels for a flap covering the contralateral thigh., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Comparing to other primates, one of the most important specificities of the human anatomy are consequences of bipedalism. Although bone consequences are well known (lumbar lordosis, horizontal position of the foramen magnum, lengthening of the lower limbs, reduction of the pelvis, specialization of the foot), consequences of our locomotion on the Latissimus dorsi are still unclear., Materials and Methods: One dissection of a chimpanzee Latissimus dorsi (Pan troglodytes) has been performed and compared to 30 human Latissimus dorsi dissections (10 fresh cadavers and 20 formoled cadavers). In each dissection, the existence of direct muscular insertions on the iliac crest has been investigated and the constitution of the thoracolumbar fascia has been described., Results: In chimpanzee dissection, a muscular direct insertion of the Latissimus dorsi was present on the iliac crest of 9 cm long. The TLF was made of the superficial and the deep fascias of the Latissimus dorsi and the superficial fascia of the erector spinae muscles which was deeper. In man, there was no direct muscular insertion of the Latissimus dorsi in 90 % of cases, the TLF was constituted the same way., Conclusion: This study suggests that the Latissimus dorsi has been separated from the iliac crest in man during the evolution because of the permanent bipedalism and that it stayed inserted on the iliac crest in chimpanzee because of the brachiation., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)