The thoracodorsal artery is the continuation of the subscapular artery after it gives off the circumflex scapular branch, descending along the posterior axillary wall to supply the latissimus dorsi muscle. It enters the deep surface of the latissimus dorsi with the thoracodorsal nerve, and within the muscle it divides into medial and lateral branches that run parallel to each other and can be identified as pedicle landmarks for flap design.
| Origin | Subscapular artery, as its continuation after the circumflex scapular artery |
|---|---|
| Course | Descends along the posterior axillary wall with the thoracodorsal nerve to enter the deep surface of latissimus dorsi |
| Branches |
|
The thoracodorsal artery is the dominant pedicle of the latissimus dorsi flap, used for breast reconstruction and for coverage of the scalp, chest wall, upper limb and head and neck. Inside the muscle it divides into a lateral (descending) branch along the lateral border and a medial (transverse) branch near the upper border, which allows muscle-sparing flaps that take only the segment supplied by one branch. Skin perforators from these branches supply the thoracodorsal artery perforator (TAP or TDAP) flap without taking muscle, and the serratus branch supplies the serratus anterior flap. Doppler or CT angiography maps the branches and perforators, and patency should be confirmed after previous axillary surgery.
Previous axillary lymph node dissection, axillary radiation, or sentinel node biopsy may damage the thoracodorsal vessels, rendering the latissimus flap unreliable; preoperative Doppler assessment and angiography are essential before planning a latissimus flap in patients with prior axillary surgery.
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