Successful Latissimus Dorsi Flap Reconstruction Following Intraoperative Division of the Thoracodorsal Pedicle During Breast Cancer Surgery: A Case Report.

The latissimus dorsi (LD) musculocutaneous flap remains a reliable option for breast and chest wall reconstruction because of its consistent anatomy and dependable vascularity. The flap is traditionally considered dependent on the thoracodorsal vascular pedicle, and division of this pedicle is often regarded as a contraindication to its use. We report the case of a 53-year-old woman with locally advanced right breast carcinoma who underwent modified radical mastectomy following neoadjuvant systemic therapy. During axillary dissection, the thoracodorsal vessels were intentionally ligated and divided because of dense adherence to metastatic lymph nodes, whereas the angular branch and multiple intercostal and lumbar perforators were preserved. Given the extensive postmastectomy defect, reconstruction using an LD flap was considered. Intraoperative indocyanine green (ICG) angiography demonstrated satisfactory flap perfusion despite division of the dominant pedicle, allowing successful flap inset. The postoperative course was uneventful, with only minimal marginal flap necrosis that resolved with conservative management and without the need for additional surgical intervention. This case demonstrates that thoracodorsal pedicle division does not necessarily preclude successful LD flap reconstruction when collateral vascular pathways are preserved. Intraoperative ICG angiography provides valuable real-time assessment of flap perfusion and may facilitate safe reconstructive decision-making in challenging oncologic situations.