Latissimus Dorsi Flap for Shoulder and Elbow Wound Coverage

Description

In this instructional video, Dr. Janet Conway discusses the latissimus dorsi flap, an important surgical technique for addressing various upper extremity problems. The flap is primarily used to cover anterior shoulder wounds and restore elbow function, including both extension and flexion. Dr. Conway explains the anatomy associated with the latissimus dorsi, specifically its innervation and blood supply from the thoracodorsal artery and nerve, while emphasizing the significance of dissecting these structures properly during the surgery.



The procedure starts with a curved incision conforming to the lateral aspect of the back, allowing access to the latissimus dorsi muscle. Dr. Conway discusses the positioning of the patient, noting that a prone or lateral position can be chosen based on the specific requirements of the procedure. As she dissects the muscle, she highlights the importance of careful handling to avoid complications such as seromas at the donor site. Dr. Conway navigates through the thick layers of skin and fascia, using cautery to manage bleeding from the perforating vessels.



She articulates the process of elevating the muscle while paying attention to the surrounding structures, including the serratus muscle. Throughout the video, Dr. Conway shares insights regarding the dissection technique, including when to apply blunt dissection and the identification of the neurovascular bundle that supplies the latissimus dorsi. She stresses the muscle's versatility, explaining that it can be used effectively for both shoulder and elbow coverage.



As the surgery progresses, Dr. Conway demonstrates how to safely detach the muscle from its attachments while ensuring the integrity of the blood supply. The video culminates in the integration of the flap for covering the shoulder wound, concluding with a discussion on the potential applications of the latissimus dorsi flap in orthopedic surgeries.

Specialties