Whole or split latissimus dorsi muscle for intrathoracic transposition

We read with interest the paper by Abolhoda et al. about a harvest technique for pedicled transposition of latissimus dorsi muscle, and congratulate the authors [1]. We are used to transpose intrathoracically the whole latissimus dorsi muscle to obliterate an infected apical or mid-thoracic dead space and we use the same technique as described by the authors but we have modified the harvest technique when we use the latissimus dorsi muscle to protect a bronchial stump at risk of bronchial insufficiency. The latissimus dorsi vasculature is such that vascular supply to the muscle is based on the thoracodorsal vessels. Once these vessels enter the muscle they show a constant division into a horizontal branch and a branch that runs about 2.5 cm medial and parallel to the anterior muscle border [2]; thus an ideal condition for the creation of a split muscle flap with a great rotation arc that can be placed into the chest cavity without tension and can be stuck on the bronchial stump at risk of insufficiency. This split muscle flap is based on the lateral branch only of thoracodorsal vessels that can be easily observed and controlled while raising the flap. This harvest technique is very easy and quicker than the harvest technique required for the whole latissimus dorsi, the bulk of the split muscle flap is such that it can be passed through an intercostal space even without rib resection and the flap is very well vascularised. We have since now used this technique in 13 patients with bronchial stump at risk of bronchial insufficiency with good results and without any complication.