Endoscopic harvest of the latissimus dorsi muscle using the balloon dissection technique

The latissimus dorsi muscle is a workhorse for reconstruction, including pedicled and microvascular free-tissue transfers. The purpose of this study is to determine the feasibility of endoscopic harvesting of the latissimus durst muscle as either a pedicled flap or a microvascular free-tissue transfer flap. The donor site is not exempt from morbidity, including seroma, hematoma, infection, and unsightly scarring. We present our technique of endoscopic harvest of the latissimus dorsi muscle based on 10 cadaveric dissections and 6 live patient surgical harvests. Balloon dissection using fascial clefts facilitates harvest. A transverse 4- to 5-cm posterior infraaxillary incision is made. Under direct visualization, the neurovascular pedicle is identified. A second transverse 1.5-cm incision is marie in the area of the auscultatory triangle just superior to the superior border of the latissimus dorsi muscle. Using this port, a General Surgical Innovations 1500-cc balloon dissector is inserted and inflated in the epimuscular plane. It is directed inferolaterally to the paraspinous muscular perforators and superior to the lumbar muscular perforators. This is repeated in the submuscular plane with a 750-cc balloon dissector. A 10-mm zero)-degree endoscopic camera is inserted. A 5-mm lower lumbar incision port facilitates harvesting, which is accomplished by means of' the posterior infraaxillary incision. The optical cavity in the epimuscular plane is maintained with CO2 insufflation. The balloon device greatly speeds dissection and, if properly positioned, does not disrupt perforator blood supply. The latissimus dorsi muscle can be harvested either as a pedicled flat breast or chest-wall reconstruction or as a microvascular free-tissue transfer flap for more distant use. Endoscopic latissimus muscle harvest with balloon dissection technique is feasible, safe, and efficient in the clinical setting. There is potential for reduced donor-site morbidity and improve aesthetic result.