the thoraca dorsal artery perforator flap utilizes a skin paddle that lies above the latismus dorsi muscle the flap is supplied by a myocutaneous perforator arising from the descending branch of the thorica dorsal pedicle which runs along the deep surface of the muscle in the harvest procedure the pedicle is divided at the descending branch the medial branch the serratus anterior branch embed the proximal dorica dorsal pedicle incision begins at the axilla tracing the anterior border of the latissimus dorsi muscle as dissection reveals the muscle care is taken to continue dissection along the axis of the anterior border this would prevent injury to the perforator which arises on the lateral surface of the muscle at the distal end of the incision careful dissection is performed to reveal the myocutaneous perforator the perforator is likely found about two centimeters away from the anterior border of the muscle with the perforator identified the latissimus dorsi muscle is dissected away from the serratus anterior muscle revealing the serratus anterior branch of the pedicle the long thoracic nerve is located anterior to this branch and is preserved dissection proceeds towards the axilla revealing the thoracic dorsal pedicle the descending branch of the pedicle can be identified including the nerve to latissimus dorsi which is preserved the perforator is followed through the muscle to the pedicle dividing the overlaying muscle along with the medial branch and the serratus anterior branch the posterior border of the skin paddle is marked and traced with electrocautery the paddle is carefully dissected away from the muscle leaving a safe margin surrounding the perforator the descending branch of the pedicle is divided distal to the perforator the perforator along with a small cuff of muscle tissue is lifted from the latissimus dorsi muscle at the proximal end the thoracodorsal pedicle is divided and the flap is fully mobilized prior to