The thoracodorsal vein accompanies the thoracodorsal artery along the posterior axillary wall, draining the latissimus dorsi and the serratus anterior, and joining the subscapular vein to reach the axillary vein. It is the venous drainage of the latissimus dorsi flap and must be included in the free flap pedicle during microsurgical breast reconstruction.
| Origin | Venous tributaries from latissimus dorsi and serratus anterior |
|---|---|
| Course | Ascends with the thoracodorsal artery and nerve along the posterior axillary wall and drains into the subscapular vein |
| Branches |
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The thoracodorsal vein is the main venous pedicle of the latissimus dorsi flap, pedicled or free, and of the thoracodorsal artery perforator (TDAP) flap. Its calibre (typically 2-3 mm) and length make microsurgical anastomosis straightforward. It is preserved during axillary node dissection by keeping the dissection away from the thoracodorsal neurovascular bundle on the posterior axillary wall. Previous axillary surgery may have injured or thrombosed it, so its patency should be confirmed before relying on a latissimus or TDAP flap for breast reconstruction.
Previous axillary clearance for breast cancer may have ligated or damaged the thoracodorsal vein, rendering the latissimus dorsi free flap unreliable as the venous pedicle is absent; preoperative duplex imaging or angiography confirms patency before committing to a latissimus flap for breast reconstruction.
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