Thani ¢ Applications Coverage Head and Neck Thorax Myelomeningocele Upper Extremity Abdomen, Reconstruction Breast Abdominal Wall Functional Muscle Pectoralis (Poland’s Syndrome) Triceps Biceps Cardiac Assistance Microvascular Transplantation Distant Coverage Head and Neck ‘Trunk Upper Extremity Lower Extremity 565Regional Flaps: Anatomy and Basic Techniques / Posterior Trunk ‘566 ‘Secondary segmental pedicles: Lateral row-branches of posterior intercostal artary and vin s,); ‘meal zon-—branches of umbar ator and veln (63) ‘Dominant pects: Thoracadorsal artery (0)Latissimus Doesi lap 567 FEATURES LOCATION: A large, flat, triangular muscle covering the posterior inferior half of the trunk. Its superior fibers are deep to the trapezius muscle. The remainder of the muscle is superficial to the muscles of the posterior trunk, including the erector spinae, the serratus posterior inferior, and the serramis anterior muscles. SIZE:25 X 35 cm ‘ORIGHY:A broad aponeurosis oining the posterior layer ofthe thoracolumbar fascia and attaching to the spine of the lower sixth thoracic vertebrae, sacral vertebrae, supra~ spinal ligament, and posterior iliac erest. The muscle also has some small muscular slips of origin from the lower four ribs interdigitating with the slips of origin of the external oblique of the abdomen. The superior border of the muscle is largely free of attachments with the exception of the attachment to the scapula, and the lateral border isa free edge in which the deep surface merges with the underlying muscle fibers of the serratus anterior muscle. INSERTION: The muscle fibers converge in a spiral fashion to form the posterior fold of the axilla adjacent to the lower border of the teres major muscle, The muscular tendon then inserts into the intertubercular groove of the humerus. Flap Type: Muscle or musculocutaneous Pattern of Circulation: Type V ‘VASCULAR ANATOMY Dominant Pedicle: Thoracodorsal artery and venae comitantes REGIONAL SOURCE: Subscapular artery and vein LENGTH:8.cm, DIAMETER: 2.5 mm LOCATION: Enters the deep surface of the muscle in the posterior axilla 10 cm inferior to the muscle insertion into the humerus. Secondary Segmental Pedicles: Lateral row—four to six perforating arterial branches and venae comitantes REGIONAL SOURCE: Posterior intercostal artery and vein LENGTH: 2 to3. cm DIAMETER:0.6 mm. LOCKTION: Lateral to lumbosacral fascia Secondary Segmental Pedicles: Medial row—four to six perforating vessels and venae comitantes REGIONAL SOURCE: Lumbar artery and vein LENGTH: 1 to2.em_ DIAMETER:0.5 mm LOCATION: Adjacent to site of muscle origin into lumbar vertebrae