|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| A. The skin island is depicted here paralleling the central fibers of the latissimus in an oblique fashion down toward the posterior iliac spine. This island can be placed transversely, obliquely downward as shown. Its width may be up to 8 cm and still permit primary closure of the defect, depending on the size of the patient and the amount of subcutaneous tissue. The end of the incision is brought into the axilla just anterior to the posterior axillary fold to permit access to the apex of the axilla and the base of the pedicle. A Z-plasty is placed in the axilla if the dissection is carried to the apex.
A. The posterior-superior margin of the latissimus is separated from the teres major at the angle of the scapula. These two muscles are closely adherent as they approach their insertion on the medial surface of the humerus. If the upper border is mobilized, the dissection can be carried downward anteriorly above the serratus. It is often better to complete this dissection before the anterior dissection so that one does not dissect deep to the serratus in the anterior dissection. Large perforators are encountered to the intercostal vessels in the posterior axillary line, entering the deep surface of the muscle. These should be carefully tied or clipped.
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