The thoracodorsal vein accompanies the thoracodorsal artery, draining the latissimus dorsi and serratus anterior into the subscapular vein. It is the venous pedicle of the latissimus dorsi myocutaneous flap and the thoracodorsal artery perforator (TDAP) flap.
The thoracodorsal vein is the venous pedicle anastomosed during latissimus dorsi free flap transfer — its calibre and length determine the ease of venous anastomosis. It is preserved during axillary node dissection by keeping the dissection lateral to the subscapular-thoracodorsal vascular pedicle. Thoracodorsal vein thrombosis after axillary surgery may compromise the latissimus flap used for breast reconstruction in the same operative field.
Inadvertent thoracodorsal vein injury during axillary clearance devascularising the latissimus dorsi pedicle planned for immediate breast reconstruction, requiring flap plan revision.
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