背阔肌皮瓣

The latissimusdorsi muscle is the largest muscle in the body, up to 20 by 40 centimeters, allowing coverage of extremely large wounds. In spite of its size, no significant donor functional deficit results from removal of the muscle. It is the largest flap that can be harvested on a single predicle, and can even be combined with the serratus, scapular or parascapular flaps, to create a flap complex that can cover massive wounds. In the normal population the muscle is quite thin (less than 1 centimeter thick), allowing it to be draped over irregular surfaces with ease. With the rectus muscle and radial forearm flap, it represents one of the workhorse flaps in reconstructive microsurgery. When re-innervated using the thoracodorsal nerve, the latissimus can be used as a functional muscle.
背阔肌是身体面积较大肌肉支一，达到20*40cm，可以转移修复巨大创面，尽管其体积大，但对供区功能影响很小。

在普通人群其肌肉很薄（小于1cm）,可以修复不规则创面，也可以吻合胸背神经，作为功能肌皮瓣使用。

The muscle takes origin on the iliac crest inferiorly and the thoracolumbar fascia posteriorly near the midline. It inserts into the humerus where it acts as a humeral adductor and internal rotator. The posterior axillary fold is made up of the most superior aspect of the muscle that begins to narrow before it forms the tendon of insertion. The nerve supply is via the thoracodorsal nerve, a branch of the posterior cord of the brachial plexus. Lesions of C-7 will affect latissimus function. The nerve closely accompanies the thoracodorsalartery.Thelatissimus muscle blood supply is via the subscapular artery, a branch of the axillary artery.
起点：下6个胸椎棘突，腰背筋膜，髂嵴，下3-4个肋骨；以肌腱形式止于肱骨结节间沟底；功能：伸展、内收、内旋肱骨，攀爬时拉起肢体，并可辅助
吸气。

神经支配：臂丛神经后束分支--胸背神经（C7）；血供：肩胛下动脉分支--胸背动脉。

The subscapular sends off a circumflex scapular branch posteriorly and then distributes a serratus branch before it enters the substance of the muscle on its undersurface.
肩胛下动脉首先发出旋肩胛动脉然后分出前锯肌肌支，最后进入背阔肌并走行于肌肉下方。

（见图1）
The subscapular artery can be from 2 to 5 millimeters in size, while the thoracodorsal artery ranges from 1 to 3 millimeters. The venae commitans is usually slightly larger.
肩胛下动脉直径为2-5mm，胸背动脉为1-3mm，其伴行静脉一般比动脉稍粗大。

The muscle is also supplied by perforators from the thoracic intercostal and lumbar arteries that allow it to be used as a pedicled flap that can resurface posterior defects. These vessels are quite small with short leashes and not typically used for microsurgical reconstruction.
背阔肌通过交通支与肋间动脉和腰动脉连续，通过交通支可以将背阔肌向下方旋转修复骶尾部皮肤缺损，但由于其血管较细小，供应范围少，不是典型的外科重建选择皮瓣。

The patient is placed in the lateral decubitus position on a beanbag, with an axillary roll placed in the dependent axilla. The ipsilateral arm is prepped completely and left in the operative field, allowing it to be freely moved about the field. For most of the procedure it is kept abducted and resting on a well padded sterile Mayo stand placed anterosuperiorly to the patient. The latissimus border is outlined with a marking pen. The incision is then marked extending from the axilla or the posterior axillary fold, then inferiorly and medially over the latissimus muscle. The length of muscle needed will dictate the incision length. Alternatively, if a skin paddle is necessary, it is marked over the flap. A pencil Doppler can be used to ensure the presence of a perforator in the skin paddle.
患者取健侧卧位，患侧在上，并用支架固定，身体同侧上臂及手完全消毒，以便术中移动；手术过程中需要保持肩外展，标记背阔肌边界，切口起自腋窝或腋窝后壁，向下、向背阔肌中间部位延伸，如果需要带皮肤转移，则需如下图虚线示切取方法，可以用多普勒测定皮支穿出点。

在肌肉下方分离，向远端根据需要显露肌肉，如需重建肌肉，则在远端带部分腰背筋膜以便进行缝合修复。