A 58-year-old woman underwent immediate reconstruction with an expander following total mastectomy for ductal carcinoma in situ (DCIS, see breast cancer ). Following radiation therapy and several weeks of progressive expansion, a permanent prosthesis was placed. A skin grafted nipple-areolar complex was created subsequently. Two months later the patient developed wound breakdown with exposure of the prosthesis and superimposed infection. The prosthesis was removed. Six months following resolution of the infection, the patient presents for reconstruction with a pedicled latissimus dorsi flap.
The latissimus dorsi originates from a broad aponeurosis attached to all the vertebral spinous processes caudal to T6, from the lumbodorsal fascia, the posterior part of iliac crest and the lower three or four ribs. It inserts into the crest of the lesser tubercle of the humerus and the floor of the intertubercular groove. It surface is subcutaneous except for the small cephalad triangle covered by the caudal part of the trapezius. Its superior border attaches to the inferior angle of the scapula.
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