Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 19:
Latissimus Dorsi Muscle Transplantation
  FIG. 19-27. A large 14 x 27 cm myocutaneous latissimus flap was elevated to resurface the anterior half of the skull.

FIG. 19-28. The area of excised unstable scar and the underlying skull are reconstituted with multiple split-rib grafts in a barrel-stave fashion. The large latissimus dorsi myocutaneous flap is ready for insertion into the defect.

FIG. 19-29. The myocutaneous flap restored the skull contour and provided protection. Reconstitution of the anterior hairline is contemplated with island flaps from the occipital area. Side view.

FIG. 19-30. Front view.


A 32-year-old man underwent resection of a scalp fibrosarcoma, which recurred.

FIG. 19-31. The skin grafts originally applied were adherent to bone.

FIG. 19-32. The resected cranial bone and tumor.

FIG. 19-33. A myocutaneous latissimus flap was elevated. The underlying seventh rib was isolated subperiosteally.

FIG. 19-34. Rib is split sagittally and transversely to form four struts.


FIG. 19-35. The bone grafts have been wired into place ready to be covered with the flap.

FIG. 19-36. Early postoperative view.

FIG. 19-37. Follow-up at 5 years. At 2 years, a small recurrence posteriorly had been excised and the area covered with an occipital scalp flap.


This patient suffered total avulsion of the scalp in an industrial accident. The thin split-thickness skin grafts used to cover the periosteum were constantly breaking down. (From Whitney, T.M., Buncke, H.J., Alpert, B.S., Buncke, G.M., and Lineaweaver, W.C.: The serratus anterior free flap: Experience with 100 consecutive cases. Plast. Reconstr. Surg. In press, 1990.

FIG. 19-38. View of the posterior part of the scalp, which has multiple ulcers. The foam-rubber pattern is an estimate of the amount of tissue needed to cover the skin-grafted area.

FIG. 19-39. The entire latissimus is laid out on the side of the chest with the three slips of the serratus on the upper anterior edge, which increase the potential surface area that can be covered by 25%.

next page...

  2002 © This page, and all contents, are Copyright by The Buncke Clinic