Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
Introduction:  
The Latissimus Dorsi (LD) flap is a versatile 
muscular or musculocutaneous flap that can be used 
to cover defects in a wide area that spans the anterior 
chest, axilla, shoulder, anterior and lateral neck, 
thoracic spine, and even the oral cavity and 
oropharynx. It is robust, meaning that it can 
successfully be used by “occasional” plastic 
surgeons. Its primary neurovascular pedicle is easy 
to find and to preserve during harvest.  
The LD is a fan-shaped muscle about 30 cm 
in length, originating from the spinous processes of 
T7-L5 vertebrae, the 7th to 12th ribs, and the posterior 
superior iliac spine. It inserts on the medial aspect of 
the head of the humerus, between the insertions of 
the teres major and pectoralis major muscles. It 
functions to adduct and internally rotate the upper 
arm, as well as to support the trunk. In its absence 
arm adduction is weakened and the back symmetry 
is lost. Its primary vascular supply is the 
thoracodorsal artery and vein, which originate off the 
3rd portion of the subclavian vessels. Its nerve supply 
is the thoracodorsal nerve, which runs with the artery 
and vein.  
The standard LD flap is created by detaching 
the fan-shaped portion of the muscle from the chest 
wall, often including some of the overlying skin. 
When completely detached up to the axilla, it can 
provide soft tissue coverage in a range up to about 
30cm from the head of the humerus. This area 
encompasses the upper arm, axilla, breast and 
anterior chest wall, anterior and lateral neck, and 
even the floor of mouth, cheek, or oropharynx.  
Although the LD flap will easily reach the 
oral cavity and even the temporal region or skull 
base, it is not commonly used in head and neck 
reconstruction. This is because the volume of muscle 
adds  bulk wherever it is placed, and there are other 
easier and less morbid flap options in the head and 
neck, described elsewhere in this Manual.  
The LD flap is most commonly used for 
reconstruction of chest wall defects, reconstruction 
after mastectomy, and closure of defects on the 
anterior or lateral neck if a large amount of tissue is 
needed. This flap can be transferred with muscle 
alone, without a skin paddle.  
 
The latissimus dorsi (Red Arrow) is a long, flat, fan-shaped 
muscle which can be rotated around the axis of its 
thoracodorsal vascular pedicle, with or without division of the 
muscle near to its insertion on the humerus. 
 
 
For deeply scarred burn contractures, a musculocutaneous flap 
provides a superior result compared to a full thickness skin 
graft. Additionally, a neck brace is not required during healing, 
as it would be with a skin graft to prevent a recurrence of the 
contracture. 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
For breast reconstruction, a breast tumor that 
cannot be closed primarily after mastectomy should 
be treated with neoadjuvant chemotherapy. LD flap 
closure is reserved for those tumors which remain too 
large for primary closure after chemotherapy, or for 
debulking of tumors that do not respond to 
chemotherapy at all. The surgeon should be careful 
to assess the axilla, as a high lymph node burden will 
make harvesting this flap impossible. Decision-
making is discussed further in the “Malignant Breast 
Disease” Section.  
 
This patient underwent neoadjuvant chemotherapy for locally 
invasive breast cancer. The tumor responded to treatment, but 
a mastectomy would still leave a wound that is too large to 
close. A skin graft is another option, but would be much worse 
cosmetically.  
 
The main disadvantage of the LD flap is that 
it requires the lateral decubitus position to harvest. 
(See Lateral Decubitus Position.) When it is used to 
cover a defect in the anterior chest wall or neck, the 
patient must often be repositioned. In most  
situations, the tumor is first removed in supine 
position, the defect is measured, and then the patient 
is placed in the lateral decubitus position and the 
surgeon harvests the flap. Harvesting a flap that is too 
large or too small has disadvantages at both the donor 
and recipient sites. This has several implications:  
● For breast cancer, mastectomy can first be 
done in the supine position (with or without 
axillary dissection.). The patient is then 
placed in the lateral decubitus position, the 
flap is harvested, and the mastectomy defect 
is closed with the flap in this position. 
● For anterior neck contracture release, even an 
experienced surgeon will have difficulty 
predicting the size of the defect before 
releasing it. The safest option is to release the 
contracture and measure the defect in the 
supine position, then harvest the flap in the 
lateral decubitus position, then return the 
patient to supine position to close the defect. 
● For closure of floor of mouth or neck defects 
after cancer resection, the same principles 
may apply: the resection is done in supine 
position, the flap is harvested in lateral 
decubitus position, then the defect is closed 
with the patient back in supine position.  
 
The steps of the LD flap creation and placement are 
as follows: 
● The 
defect 
is 
created 
(tumor 
resection, 
contracture release) and measured.  
● The patient is placed in the lateral decubitus 
position.  
● The flap is carefully measured, being sure that 
the point of rotation will allow it to reach the 
defect, especially if a skin paddle will be 
included, as described here. 
● Incisions including a skin paddle are made 
● The muscle is dissected off of the surrounding 
skin and chest wall 
● The flap is rotated into place or moved into a 
position where it can be retrieved.  
● The skin of the harvest site is closed. 
● The patient is repositioned if necessary and the 
flap is placed and sutured into the defect. 
 
Steps: 
1. Careful examination in the clinic, with the patient 
unclothed, allows the surgeon to visualize the 
anterior crease of the LD muscle and assess 
whether its most inferior extent can reach the 
planned defect. The axilla should be examined 
carefully, as axillary adenopathy will make 
complete mobilization of the flap very difficult 
or impossible.  
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Palpation and grasping of the posterior axillary fold allows the 
surgeon to feel the LD muscle. Patient is in right lateral 
decubitus position, head towards the top and facing toward the 
left side of the photo. Source: Hallock GG and Young Sang Y, 
Journal of Medical Insight https://jomi.com/article/290.7 
 
2. The patient should be explained that they will 
have weakness of shoulder adduction and an 
asymmetrical appearance of the back after 
harvest of the LD.  
 
With the patient in the seated position, the anterior border of 
the LD (Purple Line) can be marked. The anticipated distance 
from the axilla to the defect can be used to position the skin 
paddle (in Red) 
 
3. General anesthesia is induced. Avoid IV cannula 
placement in the ipsilateral arm. 
4. The patient is positioned for tumor resection, 
contracture release, debridement or other 
creation of the soft tissue defect. 
5. If performing a mastectomy and axillary 
dissection, take care to identify and preserve the 
thoracodorsal neurovascular bundle during the 
dissection (See Chapter, Axillary Dissection.) 
You can later follow this vessel caudally and 
identify where it enters into the latissimus dorsi 
muscle, 
supplementing 
the 
identification 
technique that is described below.  
 
The thoracodorsal neurovascular bundle, shown here during 
left axillary dissection, runs deep to the latissimus dorsi, 
consistently about 1-2cm medial to its anterior edge. It is large 
and easy to identify up in the axilla.  
 
6. Depending on the operation, it may be possible 
to harvest the latissimus dorsi flap first, or to 
place it while the patient is in the lateral 
decubitus position. This approach allows only 
one position change during the operation. 
Alternatively, it may be necessary to change the 
patient’s position twice.  
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Right axillary burn scar contracture after release and closure 
with a LD flap. As this defect was in the axilla, all of the steps 
of the operation could be done in the left lateral decubitus 
position. The skin paddle originated from healthy skin on the 
back caudal to the burn. The defect where the paddle originated 
is now the horizontal component of the wound closure (Black 
arrow.)  
 
7. Measure the defect in horizontal and vertical 
dimensions.  
 
Anterior neck contracture after release. The horizontal (Blue 
line) and vertical (Purple line) dimensions of the defect are 
measured and recorded. In this case, the neck has been 
extended to make sure that the space is completely filled by the 
skin paddle. Note that the patient must be in supine position for 
this release. 
 
8. The distance from the posterior aspect of the 
axilla to the most lateral aspect of the defect is 
measured.  
 
Measuring the distance from the axilla to the closest edge of the 
defect. A gentle curve is included to allow the flap to pass 
around, rather than directly anterior to, the shoulder.  
 
9. A temporary dressing is placed over the defect.  
10. The patient is placed in lateral decubitus position. 
11. The anterior border of the LD is palpated and 
marked. A point 10cm below the axilla is also 
marked, indicating the location where the 
thoracodorsal vessels enter the muscle. 
 
Left side of the chest, seen from the patient’s front, showing the 
anterior border of the latissimus dorsi muscle and a point 10cm 
below the axilla and posterior to the border of the muscle, 
where the thoracodorsal vessels enter the muscle. During the 
surgery, the surgeon will make note of this location when 
dissecting deep to the muscle and watch out for the vessel, as 
described further below. Source: Hallock GG and Young Sang 
Y, Journal of Medical Insight https://jomi.com/article/290.7 
 
12. A skin paddle matching the dimensions 
measured in step #8 is drawn. The orientation is 
considered such that when the muscle flap is 
rotated into place, the skin paddle will match the 
defect. All of the skin paddle should lie well 
above LD muscle, a few cm posterior to its 
anterior border. If a sterile pen is not available, 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
light scratches with a sterile needle can be used 
to mark the measurements.  
 
The distance from the axilla to the defect (Red line,) taken in 
Step #8, is measured from the axilla along the anterior border 
of the latissimus dorsi. The skin paddle is then positioned so 
that it is over muscle.  
 
 
Grasping the skin in the area where the skin paddle is planned: 
it is loosest when grasped transversely as shown. A defect that 
remains after this skin is removed will be likely to close. For 
these photos, the patient’s head is to the left of the photo and 
they are facing towards the bottom of the photo. Source: 
Hallock GG and Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7 
 
 
Mark the planned skin paddle relative to the latissimus dorsi 
muscle (dotted line.) Source: Hallock GG and Young Sang Y, 
Journal of Medical Insight https://jomi.com/article/290.7 
 
13. Incise the anterior skin paddle, superiorly and 
inferiorly, to allow you to find the latissimus 
dorsi muscle. Making this incision first allows 
the surgeon to locate the LD muscle relative to 
the flap, and to visualize exactly how far caudally 
the muscle extends. The paddle can still be 
repositioned if necessary, as only part of it has 
been incised.  
 
Incision of the anterior portion of the planned skin paddle. This 
will be carried down to the latissimus dorsi muscle. As you 
dissect through the subcutaneous fat, taper incision away from 
the skin paddle, rather than making it straight downwards. If 
necessary, the paddle can still be trimmed or re-shaped at this 
point depending on the muscle underneath. Source: Hallock 
GG and Young Sang Y, Journal of Medical Insight  
https://jomi.com/article/290.7 
 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
In the base of the incision, the transversely oriented fibers of 
the latissimus dorsi muscle are seen. Source: Hallock GG and 
Young Sang Y, Journal of Medical Insight 
 https://jomi.com/article/290.7 
 
14. Further dissect out the anterior border of the 
latissimus dorsi muscle, confirming that the skin 
paddle will lie completely on top of the muscle. 
Once you are satisfied that this is the case, make 
an incision proximally along the muscle. In this 
case, it is shown over the body of the muscle, 
extending from the previously measured point 
10cm below the axilla, to the middle of the 
planned skin paddle. If you have done an axillary 
dissection and identified the thoracodorsal vessel 
already, this incision can be made from the 
axillary incision and carried downwards along 
the anterior border of the latissimus dorsi.  
  
An incision along the latissimus dorsi muscle (solid Purple 
line,) ending near the measured point of entrance of the 
thoracodorsal vessels into the muscle, will allow easier 
dissection of the LD muscle off of the surrounding skin and 
deeper muscles of the chest wall. Source: Hallock GG and 
Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7  
 
15. Elevate the skin off of the LD surrounding the 
pedicle.  
 
Incise the skin down to the fascia of the muscle. The 
thoracodorsal vessels are deep to the muscle and are not 
vulnerable to injury at this point. Source: Hallock GG and 
Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7 
 
 
Dissect the subcutaneous fat off the LD muscle, all the way to 
the anterolateral and posteromedial edges of the muscle. 
Source: Hallock GG and Young Sang Y, Journal of Medical 
Insight https://jomi.com/article/290.7 
 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
At the anterior border of the muscle, dissect this edge of muscle 
off of the surrounding tissue. The serratus anterior muscle, with 
its more transversely oriented fibers, will be underneath. 
Source: Hallock GG and Young Sang Y, Journal of Medical 
Insight 
https://jomi.com/article/290.7 
 
16. Incise the skin to make the distal edge of the skin 
paddle. Make this incision diagonally away from 
the skin as above, to assure a good base and blood 
supply for the skin from the muscle underneath.  
 
The skin of the caudal side of the skin paddle is incised in a 
diagonal manner, assuring that the skin rests on a solid base 
and has good blood supply from the muscle underneath. 
Source: Hallock GG and Young Sang Y, Journal of Medical 
Insight  
https://jomi.com/article/290.7 
 
17. Some surgeons “tack” the dermis of the skin 
paddle to the muscle fascia circumferentially, to 
prevent shear forces from damaging the paddle’s 
blood supply. We do not do this routinely but if 
the paddle’s attachment to the muscle is under 
tension once it is in place, we will do this with 
interrupted absorbable sutures.  
18. Beginning at the inferior edge of the skin paddle, 
dissect the latissimus dorsi muscle off of the 
chest wall and serratus anterior muscle.  
 
After dividing the caudal end of the LD muscle, lift the muscle 
upwards and begin dissecting it off the chest wall. Source: 
Hallock GG and Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7 
 
 
As you continue the dissection in a cranial direction, the plane 
will become more clear. Either dissect all of the muscle at this 
point, or divide part of it medially and leave it behind, 
preserving any of the muscle that supports the skin paddle. 
Source: Hallock GG and Young Sang Y, Journal of Medical 
Insight https://jomi.com/article/290.7 
 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
As dissection proceeds, perforating blood vessels will appear 
and must be individually ligated. Watch for signs that the 
thoracodorsal vessels are near, as shown below. Source: 
Hallock GG and Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7 
 
19. As you approach the area 10cm below the axilla, 
watch carefully for the area where the 
thoracodorsal vessels enter the muscle. One sign 
will be a “crow’s foot” of perforator vessels 
going  from the LD muscle into the serratus 
anterior muscle. These must be individually 
ligated and divided.  
 
Schematic of the neurovascular supply of the latissimus dorsi. 
The thoracodorsal vessels give off branches to the serratus 
anterior (denoted by >) and the scapula (denoted by ^). The 
branch to the serratus must sometimes be divided to mobilize 
the flap, if it needs to go far. The branch to the scapula does not 
need to be divided, but can be if more mobility is needed. 
Source: Feng AL, et al. Plast Aesthet Res 2021;8:14. 
 http://dx.doi.org/10.20517/2347-9264.2021.03 
 
 
 
During the dissection, these two vessels in the shape of a 
“crow’s foot” were seen (Black arrows.) Further careful 
dissection revealed that these were branches from the 
thoracodorsal vessels, and pointed towards the main 
thoracodorsal pedicle running into the muscle (Blue arrow.) 
Further dissection at this point should be with bipolar 
diathermy or sharp dissection and ligation, rather than 
monopolar diathermy, which can damage the blood vessels. 
Source: Hallock GG and Young Sang Y, Journal of Medical 
Insight https://jomi.com/article/290.7 
 
20. Continue to dissect the latissimus dorsi muscle 
proximally up to the axilla, dividing any 
branches of the thoracodorsal vessels that do not 
supply the LD. Dissection here should not be 
with monopolar diathermy, use bipolar if 
available, or else dissect sharply and individually 
ligate any vessels. Try to preserve a layer of fat 
around the thoracodorsal vessels rather than 
dissecting directly on them.   
21. At the medial portion of the latissimus dorsi 
muscle, there will be some muscle attachment to 
the scapula and the teres major muscle. If these 
are not too close to the main vessels, divide them 
with diathermy. 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
At the upper medial border of the left latissimus dorsi the 
muscle is adherent to the scapula and teres major muscle 
(underneath the forceps.) Source: Open Access Atlas of 
Otolaryngology, 
Head 
and 
Neck 
Surgery 
http://www.entdev.uct.ac.za/guides/open-access-atlas-of-
otolaryngology-head-neck-operative-surgery  
 
22. It is possible to mobilize the latissimus dorsi all 
the way up to its insertion on the humerus, and 
even to disconnect it here in order to get more 
length. Continue dissection as far in a cranial 
direction as you need to go. Keep the 
thoracodorsal vessels in sight at all times, 
ligating any branches that don’t go into the 
muscle. Continue until the skin paddle reaches 
the defect without any tension.  
23. Confirm that the skin paddle still has good blood 
supply after dissection. It should “blanche” (turn 
pale) and then return to normal color when you 
push gently on the skin with an instrument and 
then remove it.  
 
The handle of a hemostat was pressed gently against the skin. 
After it was removed, a faint white outline remained (Black 
arrow.) This disappeared after 5 seconds, indicating a good 
arterial supply and venous drainage to the skin paddle. Source: 
Hallock GG and Young Sang Y, Journal of Medical Insight 
https://jomi.com/article/290.7 
 
24. Once the flap is mobile, assure that there is a 
tunnel in the subcutaneous space that is wide 
enough to allow the muscle to pass without 
constricting it, as this would compromise the 
blood supply of the skin paddle. You may need 
to reposition the patient at this stage. If so, close 
part of the wound, place the flap loosely within 
the skin incision, and apply a loose dressing. 
Then re-prepare and drape the axilla and defect 
together. 
 
The defect on the back where the paddle originated has been 
closed, along with some of the vertical incision. The patient has 
been returned to the supine position. The flap, now fully 
mobilized up to the axilla, is ready to be tunneled under the skin 
of the left chest and the paddle placed in the anterior neck defect 
that resulted from contracture release.  
 
25. Pass the skin and muscle through the tunnel into 
the defect. Confirm that it lies here without 
tension and does not try to “retract” when you let 
go of it.  
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Gently pass the skin paddle through the tunnel you have 
created. In this instance, a suture has been passed through the 
skin edge and is used to gently pull it through, while the 
assistant guides it and makes sure it is not twisted or kinked in 
the process. Source: Hallock GG and Young Sang Y, Journal of 
Medical Insight https://jomi.com/article/290.7 
 
26. Once the flap is mobile, check for hemostasis at 
the harvest site. Then close the skin in two layers 
with simple interrupted absorbable sutures 
through the subcutaneous fascia, followed by 
interrupted Nylon horizontal or vertical mattress 
sutures through the skin. Using a running suture 
on the skin can lead to dehiscence of the entire 
wound if the suture breaks or tears through in one 
location, especially if there is some tension on the 
closure. Place a drain in the space where the 
muscle was harvested from, to avoid a seroma 
which can become infected.  
 
The first layer of closure of the flap harvest site is the 
subcutaneous fascia, which is closed with interrupted 
absorbable sutures. Source: Hallock GG and Young Sang Y, 
Journal of Medical Insight https://jomi.com/article/290.7 
 
 
The second layer of closure is the skin, with interrupted 
nonabsorbable sutures that distribute the tension evenly across 
the wound. Source: Hallock GG and Young Sang Y, Journal of 
Medical Insight https://jomi.com/article/290.7 
 
27. The skin paddle is sutured into place, again using 
a combination of deep absorbable and cutaneous 
nonabsorbable interrupted sutures. 
 
Flap sutured into place with a closed-suction drain to prevent 
fluid collections. Using interrupted sutures assures that if one 
stitch should pull through, the closure would still be held by the 
others.  
 
Pitfalls 
● The most dreaded complication is necrosis of 
some or all of the flap. This can be prevented by 
strictly adhering to the principles  in this article, 
reinforced below.  
● Before harvest, proper measurement of the 
distances will prevent any tension on the muscle 
or the skin once they are in place.  
● During harvest, all of the skin paddle should be 
harvested from directly above the latissimus 
Latissimus Dorsi Flap 
Richard Davis, Geoffrey Hallock, Yoko Young Sang 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
dorsi muscle. Assure that the incision through the 
subcutaneous tissue “tapers” down towards the 
muscle. The skin should rest on a base of 
subcutaneous tissue and muscle that is wider than 
the skin itself.  
● During placement of the skin paddle, it must be 
protected from shearing or being pulled away 
from the muscle when it is in place. Tack the 
dermis of the skin to the latissimus dorsi muscle 
underneath if necessary to relieve tension at this 
location.  
● Avoid tension or pressure on the muscle. Any 
skin “tunnel” that it passes through must be very 
loose.  
● If, due to improper measurement, the skin paddle 
will absolutely not reach the defect it is intended 
for, the latissimus dorsi muscle can be divided 
very high in the axilla. Take great care not to 
harm the thoracodorsal neurovascular bundle. 
Generally a few cm can be gained by this 
maneuver. Be certain that the neurovascular 
bundle is not under tension once this is done, 
since the pedicle is not protected by the muscle 
from being stretched.  
● Necrosis of a part of the skin pedicle does not 
necessarily mean that the rest of the skin will die. 
This can be managed with debridement and 
resection of the dead portion and release of any 
purulent fluid underneath. 
● Dehiscence of the flap’s donor site can be 
prevented by keeping drains in the area from 
becoming clogged. If you can keep infected fluid 
from accumulating beneath your closure, it will 
generally heal. It is acceptable to irrigate drains 
with a small amount of sterile water or saline, 
using meticulous sterile technique, to unblock 
them. If dehiscence occurs, it is managed by 
debridement of dead tissue, dressing changes and 
keeping the area clean, and repeat primary 
closure if possible. Otherwise, the defect can be 
closed with a skin graft.  
● As with Axillary Dissection, one consequence of 
this operation is frozen shoulder. Aggressive 
physiotherapy for range of movement is 
necessary, once the wounds have healed enough 
that this will not cause a dehiscence. 
 
Richard Davis MD FACS FCS(ECSA) 
AIC Kijabe Hospital  
Kenya 
 
Geoffrey Hallock MD 
Sacred Heart Hospital, St. Luke’s Campus 
Allentown Pennsylvania, USA 
 
Yoko Young Sang MD MPH 
Warren General Hospital 
Warren Pennsylvania, USA 
