Latissimus dorsi flap: a comprehensive systematic review of traditional and novel applications

Background The latissimus dorsi (LD) flap is among the most adaptable and extensively employed techniques in reconstructive surgery, providing a dependable solution for addressing a wide range of defects. Although traditionally employed for soft-tissue coverage, its indications have progressively expanded to include complex and functional reconstructions. The aim of this review was to provide a comprehensive, indication-based overview of both traditional and emerging applications of the LD flap reported in the literature. Method A systematic review was conducted in accordance with PRISMA guidelines, analysing published applications of the LD flap in reconstructive surgery. An initial search was performed up to July 30, 2024, and subsequently updated during manuscript revision to include studies published through January 10, 2026. Two independent reviewers examined the selected articles, individually extracting the relevant data, which was later combined and contrasted. Given the descriptive aim of the review, no statistical analysis was performed. Results A total of 188 full-text articles were included. Based on anatomical location, indications were categorized into breast, head and neck, thorax and back, abdomen and pelvis, and upper and lower extremity reconstruction. Both coverage and functional applications were identified. Functional reconstructions included innervated and non-innervated LD flaps used for facial reanimation, limb motor restoration, urologic reconstruction (including phalloplasty and detrusor myoplasty), diaphragmatic reconstruction, and other dynamic applications. Pedicled LD flaps were predominantly reported for anatomically adjacent defects, whereas free LD flaps were more commonly used for distant or complex reconstructions. Conclusions The latissimus dorsi flap can be configured in multiple forms to address defects across nearly all anatomical regions. Contemporary literature demonstrates a clear evolution toward functional and indication-driven applications, supported by advances in microsurgical techniques and muscle reinnervation. This descriptive synthesis provides a structured overview of reported indications and may assist surgeons in selecting reconstructive strategies based on anatomical and functional objectives.