During repair of a large abdominal wall defect harvested from latissimus dorsi, a patient later reports difficulty pressing down with the extended arm while climbing, and weakness of forceful adduction and internal rotation of the shoulder against resistance. Which nerve was sacrificed during flap elevation?

• A Upper subscapular nerve
• B Long thoracic nerve
• C Medial pectoral nerve
• D Thoracodorsal nerve ✓

Explanation

The thoracodorsal nerve arises from the posterior cord with D6, D7 and D8 fibres and runs on the deep surface of latissimus dorsi, making it vulnerable during flap harvest and axillary surgery. Latissimus dorsi powerfully adducts, extends and internally rotates the shoulder, actions used when pushing down on a cane or climbing. The upper and lower subscapular nerves supply subscapularis and teres major instead.

Reference: Gray's Anatomy for Students, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.