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Leonardis JM, Momoh AO, Lipps DB. Choosing breast-conserving therapy or mastectomy and subpectoral implant breast reconstruction: implications for pectoralis major function. Breast Cancer Res Treat 2024:10.1007/s10549-024-07381-z. [PMID: 38851662 DOI: 10.1007/s10549-024-07381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND An increasing number of women are choosing mastectomy and subpectoral implant (SI) breast reconstruction over breast-conserving therapy (BCT). It is unclear to what extent these procedures differ in their effect on the pectoralis major (PM). The purpose of this study was to assess the impact of choosing BCT or SI breast reconstruction on PM function. METHODS Ultrasound shear wave elastography images were acquired from the PM fiber regions and surface electromyography obtained activity from six shoulder muscles, while 14 BCT participants, 14 SI participants, and 14 age-matched controls remained at rest or generated submaximal shoulder torques. RESULTS BCT and SI participants were significantly weaker in shoulder adduction, while BCT participants were also weaker in internal and external rotation (all p ≤ 0.003). PM function was altered following either BCT or SI. In all treatment groups, the clavicular fiber region contributed primarily to flexion, and the sternocostal primarily contributed to adduction. However, healthy participants utilized the clavicular region more during adduction and the sternocostal region more during flexion when compared to BCT or SI participants (all p ≤ 0.049). The still intact clavicular region increased its contributions to flexion torques in SI participants compared to controls (p = 0.016). Finally, BCT and SI participants compensated for changes in PM function using synergistic shoulder musculature. CONCLUSION Both BCT and SI breast reconstruction result in significant long-term upper extremity strength deficits. Our results suggest changes to the underlying function of the PM and the adoption of unique but inadequate neuromuscular compensation strategies drive these deficits.
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Affiliation(s)
- Joshua M Leonardis
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Ak E, Ayik Ö, Berköz Ö, Kozanoğlu E, Akalin BE, Bayram S, Şahinkaya T, Emekli U. Evaluation of Shoulder Muscle Improvement in Patients Following Free Latissimus Dorsi Muscle Pedicle Flap Transfer. Plast Surg (Oakv) 2023; 31:254-260. [PMID: 37654530 PMCID: PMC10467437 DOI: 10.1177/22925503211048521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/24/2021] [Accepted: 08/01/2021] [Indexed: 09/02/2023] Open
Abstract
Aim: This study aimed to evaluate the clinical outcomes, shoulder muscle strength, and donor site morbidity following the free latissimus dorsi (LD) muscle pedicle flap transfer. Materials: Patients with free LD muscle pedicle flap reconstructions and with asymptomatic shoulders (affected and contralateral side) were included. The follow-up duration was 12 months. The combined shoulder range of motion (ROM), Constant-Murley shoulder (CMS), and quick disabilities of the arm, shoulder, and hand (QuickDASH) scores were measured preoperatively and at 1 year postoperatively. The ratio of the isokinetic muscle strength and total work was measured with an isokinetic dynamometer (Cybex 350®) both preoperatively and at sixth month postoperatively. Results: Twenty patients with a mean age of 37.06 ± 9.74 years and a mean body mass index of 23.49 ± 8.6 kg/m2 were included. The difference in shoulder ROM and CMS and increase in QuickDASH were not significant at the first postoperative year. The peak torque and total work performed decreased by 13%-16% for the adductor and extensor functions at the six month postoperatively, and these differences were significant. Although the adductor peak torque was significantly lower in the postoperative test of the operated side, no significant difference was found between the operated and unaffected shoulder peak torque values. Moreover, no significant difference was noted between the operated and unaffected shoulders in all isokinetic tests pre- and postoperatively. Conclusion: The free LD muscle pedicle flap harvest did not decrease function and ROM at the first postoperative year. The muscle strength and total work of shoulders after the LD muscle transfer returned to the preoperative condition at the sixth month, except adductor and extensor muscle strengths. However, adductor and extensor muscle strengths of the operated shoulders were not significantly different postoperatively.
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Affiliation(s)
- Erman Ak
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Ömer Ayik
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Ömer Berköz
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Erol Kozanoğlu
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Bora Edim Akalin
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Serkan Bayram
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Türker Şahinkaya
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
| | - Ufuk Emekli
- Istanbul University, Istanbul Medical Faculty, Istanbul, Istanbul, Turkey
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3
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Suhani, Saini S, Verma E, Parshad R. Muscle-Sparing Latissimus Dorsi Flap in Breast Reconstruction: Experience from a Tertiary Care Center in a Developing Country. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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4
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Müller-Seubert W, Scheibl K, Bührer G, Möbius C, Ludolph I, Horch RE, Arkudas A. Less is more - retrospective comparison of shoulder strength and range of motion between conventional and muscle-sparing harvesting technique of a latissimus dorsi flap. J Plast Reconstr Aesthet Surg 2021; 74:2527-2536. [PMID: 33814327 DOI: 10.1016/j.bjps.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/14/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The muscle-sparing latissimus dorsi flap poses an alternative to the conventional latissimus dorsi flap when a defect requires a smaller flap volume with a long vascular pedicle. The aim of the study was to analyze the functional outcome following muscle-sparing versus conventional harvest of a latissimus dorsi flap. MATERIAL AND METHODS Patients who received a muscle-sparing latissimus dorsi muscle flap transplantation (group 1) and patients with a complete latissimus dorsi muscle flap harvest (group 2) for defect reconstruction at the University Hospital of Erlangen between 2007 and 2016 were examined. The evaluation included a physical examination with the measurement of strength and range of motion of the shoulder of both the donor side as well as the nonoperated side. Furthermore, the DASH score was evaluated. Additionally, patients in group 1 received a neurophysiological examination. RESULTS The DASH score did not show statistically significant differences between both groups. Both strength (p = 0.031) and range of motion (p<0.05) of the shoulder of the donor side were statistically significantly lower than the nonoperated side in group 2, while no difference was found in group 1. The neurophysiological examination in group 1 showed a reduced nerve conduction velocity of the donor side as compared to the nonoperated side in most patients (60% and n = 3). CONCLUSION Harvesting the muscle-sparing latissimus dorsi flap leads to less functional impairments of the shoulder than harvesting the complete latissimus dorsi flap.
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Affiliation(s)
- Wibke Müller-Seubert
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
| | - Karsten Scheibl
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany; Current position: Department of Orthopaedic and Trauma Surgery, Martha-Maria Hospital, Nuernberg, Germany
| | - Gregor Bührer
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany; Current position: Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - Cornelia Möbius
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany
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Feng AL, Nasser HB, Rosko AJ, Casper KA, Malloy KM, Stucken CL, Prince ME, Chinn SB, Spector ME. Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbidities across mysofascial flaps. ACTA ACUST UNITED AC 2021; 8. [PMID: 34337111 PMCID: PMC8323836 DOI: 10.20517/2347-9264.2021.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Free tissue transfer has become the gold standard for reconstruction within the head and neck. However, there are still many instances where pedicled locoregional flaps are the optimal reconstructive option. When myofascial tissue is needed, several options have been described throughout the literature. Various trapezius flaps have been used, although these have variable vascular anatomy and significant donor site morbidity. The pectoralis major myofascial flap has become a mainstay in head and neck reconstruction for its ease of harvest and reliability but suffers from similar issues with donor site morbidity. The pedicled latissimus dorsi flap (PLDF) is another reliable option that has been used for multiple different ablative sites within the head and neck. The thin, pliable structure of the latissimus dorsi makes it a viable option for many defects, and recent reports also support its feasibility for use in an interdisciplinary two-team approach. Furthermore, the donor site morbidity of the PLDF is minimal compared to other similar myofascial options. In this article, we describe the surgical considerations and operative techniques for PLDF transfer along with a review of its associated donor site morbidity.
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Affiliation(s)
- Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hassan B Nasser
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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Breast Reconstruction in Obese Patients: The Fat Grafted Latissimus versus Abdominal Free Tissue Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2668. [PMID: 32537332 PMCID: PMC7253236 DOI: 10.1097/gox.0000000000002668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/26/2022]
Abstract
Immediate fat grafting to the pedicled myocutaneous latissimus dorsi (LD) flap has recently gained in popularity as a means to supplement volume for breast reconstruction. The aim of this study is to compare complication rates of the immediately fat-grafted LD to free tissue transfer in the obese population.
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7
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Pardiwala DN, Subbiah K, Rao N, Modi R. Latissimus Dorsi Tear in an Olympics-Level Tennis Player: Case Report and Review of Literature. Indian J Orthop 2020; 54:332-338. [PMID: 32399153 PMCID: PMC7205911 DOI: 10.1007/s43465-020-00055-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/17/2020] [Indexed: 02/04/2023]
Abstract
Latissimus dorsi tears are extremely rare and are encountered primarily in high-level athletes. Noted initially in baseball pitchers, cases have been described in other sports too, with one report of a latissimus dorsi tear at the muscle-tendon junction in a tennis player. Anecdotal outcomes have been comparative after both non-operative and operative treatments. Although no clear indications for operative intervention exist, there is a general consensus that partial non-retracted tears can be managed with non-operative treatment, whereas complete tears warrant surgical repair. This case report describes a complete rupture with retraction of the latissimus dorsi tendon that occurred during a competitive match in an international level tennis player. Due to compelling sports participation reasons, this tear was managed with non-operative treatment. The player returned to competitive tennis within 6 weeks and won the Asian Games men's doubles tennis gold medal 53 days following his injury. He has had no subsequent shoulder-related symptoms despite his continuous participation in international level tennis for the past 18 months. We analyse the role of the latissimus dorsi in tennis and also review the available literature on this uncommon sports injury.
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Affiliation(s)
- Dinshaw N. Pardiwala
- Arthroscopy Service, Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (W), Mumbai, 400053 India
| | - Kushalappa Subbiah
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Nandan Rao
- Arthroscopy and Sports Orthopaedic Service, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, India
| | - Rahul Modi
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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8
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Incidence of shoulder functional morbidity following ipsilateral mastectomy and latissimus dorsi flap reconstruction. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:448-451. [PMID: 31562025 PMCID: PMC6939003 DOI: 10.1016/j.aott.2019.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 06/01/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the incidence of shoulder morbidity in our cohort of patients with latissimus dorsi flap reconstruction after mastectomy. METHODS This is a retrospective study of prospectively collected data of 72 patients using validate Oxford shoulder score for function and quickDASH score for disability. Scores were collected preoperatively and at time of final review or study. We also reviewed patient records for patients who had a formal diagnosis of shoulder pathology. Results were analysed with student t-test. RESULTS Analysis of scores showed a statistically significant worsening of both oxford shoulder score (p < 0.005) and quickDASH score (p < 0.005), when pre and post-operative scores were compared. Seven patients had a formal diagnosis of shoulder pathology, and all of them recovered well. There was no significant difference in oxford shoulder score or quickDASH scores between patients with or without shoulder pathology. About 40% patients had some functional loss or disability at 4 years after the surgery. CONCLUSION Our study shows a high incidence of significant shoulder functional morbidity following latissimus dorsi flap reconstruction but number of patients requiring specific treatment is low. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Lohana P, Button J, Young D, Hart A, Weiler-Mithoff E. Functional recovery after bilateral extended autologous latissimus dorsi breast reconstruction: A prospective observational study. J Plast Reconstr Aesthet Surg 2019; 72:1060-1066. [PMID: 31053451 DOI: 10.1016/j.bjps.2019.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/10/2018] [Accepted: 01/06/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of unilateral extended autologous latissimus dorsi (EALD) flap harvest and axillary surgery on shoulder function has been well described, but the impact of bilateral EALD flap harvest has not been clearly defined nor is it clear whether reconstructions should be synchronous or staged. METHODS In this prospective observational study, patients undergoing bilateral EALD breast reconstruction (February 2003-December 2009) completed the disability, arm, shoulder and hand (DASH) questionnaire preoperatively and at five post-operative timepoints. Intensive shoulder physiotherapy was offered to those whose DASH score was >30 at 6 weeks or >20 at 12 weeks post-operatively. RESULTS Sixty patients underwent bilateral EALD flap breast reconstruction (51 synchronous, 9 metachronous). Patients with pre-existing shoulder pathology (n = 1) and those who failed to return any post-operative DASH questionnaire (n = 10) were excluded from initial DASH analysis. However, these eleven patients were included in a separate analysis as an intention-to-treat analysis. Statistical analysis was performed using non-parametric, Friedman test and multiple comparison model. Forty-nine patients' DASH scores were analysed. DASH score initially increased after surgery and then returned to functionally normal within 3-6 months (median DASH: preoperative = 1 vs 6 weeks post-operation = 26, p = <0.001; vs 3 months = 19, p = <0.001; vs 6 months = 13, p = <0.001); thereafter, the scores remained less than 12 (p = <0.001). Median DASH score after synchronous reconstruction was not higher than that after metachronous reconstructions, although the metachronous sample size was small. CONCLUSION With appropriate patient selection and intensive physiotherapy, bilateral EALD breast reconstruction does not appear to cause significant long-term impairment of shoulder function, and patients can now be counselled about the likely timecourse of shoulder recovery. There seems no reason to stage bilateral reconstruction to reduce shoulder morbidity.
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Affiliation(s)
- Parkash Lohana
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
| | - Jane Button
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow G1 1NH, UK
| | - Andrew Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK; Centre for Cell Engineering, College of Medical Veterinary & Life Sciences, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Eva Weiler-Mithoff
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
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10
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Reconstruction mammaire par lambeau dorsal épargnant le muscle grand dorsal (Muscle-Sparing Latissimus Dorsi, MSLD) associé à un lambeau d’avancement thoraco-abdominal et greffe de tissu adipeux autologue. ANN CHIR PLAST ESTH 2018; 63:437-446. [DOI: 10.1016/j.anplas.2018.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/19/2022]
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11
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Leonardis JM, Diefenbach BJ, Lyons DA, Olinger TA, Giladi AM, Momoh AO, Lipps DB. The influence of reconstruction choice and inclusion of radiation therapy on functional shoulder biomechanics in women undergoing mastectomy for breast cancer. Breast Cancer Res Treat 2018; 173:447-453. [PMID: 30328049 DOI: 10.1007/s10549-018-5003-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The functional implications of reconstructing the breast mound with a latissimus dorsi (LD) flap or placing an implant under the pectoralis major (PM) muscle is complicated by potential comorbidities from disinserting these muscles and adjuvant radiotherapy. We utilized novel robot-assisted measures of shoulder stiffness and strength to dissociate how breast reconstruction choice and inclusion of radiation therapy impact shoulder morbidity in post-mastectomy reconstruction patients. METHODS Shoulder strength and stiffness were collected from 10 irradiated LD flap breast reconstruction patients, 14 two-stage subpectoral implant reconstruction patients (subpectoral), and 10 irradiated deep inferior epigastric perforator (DIEP) flap patients an average of 659 days post-reconstruction. Univariate ANOVAs examined surgical group differences in strength and stiffness. RESULTS There were main effects of surgical group on vertical adduction, vertical abduction, and internal rotation strength. The LD flap group was significantly weaker than the subpectoral group in all measures and significantly weaker than the DIEP group during vertical adduction. There was also a main effect of surgical group on vertical adduction stiffness, where the LD group exhibited significantly reduced stiffness while producing vertical adduction torque. No significant differences between the subpectoral and DIEP groups existed for any measure of shoulder strength or stiffness. CONCLUSIONS Disinsertion of the LD, not the disinsertion of the PM or radiotherapy, contributes to strength deficits following LD flap breast reconstructions. The combined disinsertion of the PM and LD compromises shoulder stability in the vertical plane. Shoulder function should be a focal point of the surgical decision-making process and postsurgical care.
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Affiliation(s)
- Joshua M Leonardis
- School of Kinesiology, University of Michigan, 401 Washtenaw Ave., CCRB 3730, Ann Arbor, MI, 48109, USA
| | - Brian J Diefenbach
- School of Kinesiology, University of Michigan, 401 Washtenaw Ave., CCRB 3730, Ann Arbor, MI, 48109, USA
| | - Daniel A Lyons
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas A Olinger
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, 401 Washtenaw Ave., CCRB 3730, Ann Arbor, MI, 48109, USA. .,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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12
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Patient Reported Quality of Life and Aesthetic Satisfaction with Latissimus Dorsi Flap in Immediate Partial and Delayed Total Breast Reconstruction. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 53:42-45. [PMID: 33536825 PMCID: PMC7847730 DOI: 10.14744/semb.2018.04820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Latissimus dorsi (LD) muscle flap can be used as an alternative to abdominal flaps for autologous breast reconstruction. The aim of the present study was to present the results of the quality of life and aesthetic satisfaction of breast reconstruction surgeries with LD flap and implants. Methods: Sixteen patients who had undergone LD flap breast reconstruction were included in the study. Patients were surveyed on the quality of life and aesthetic satisfaction 12 months following breast reconstruction. Results: There were no major complications observed following surgeries. All of the patients included in the study were highly satisfied with the final aesthetic results. There was no difference in satisfaction rate between partial versus total reconstructions and between reconstruction with or without implant. Conclusion: LD flaps can be a good alternative to abdominal flaps for autologous breast reconstruction for both partial and total breast reconstruction and can achieve similar aesthetic results.
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Nelson JA, Lee IT, Disa JJ. The Functional Impact of Breast Reconstruction: An Overview and Update. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1640. [PMID: 29707442 PMCID: PMC5908499 DOI: 10.1097/gox.0000000000001640] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/29/2017] [Indexed: 01/12/2023]
Abstract
As rates of bilateral mastectomy and immediate reconstruction rise, the aesthetic and psychosocial benefits of breast reconstruction are increasingly well understood. However, an understanding of functional outcome and its optimization is still lacking. This endpoint is critical to maximizing postoperative quality of life. All reconstructive modalities have possible functional consequences. Studies demonstrate that implant-based reconstruction impacts subjective movement, but patients’ day-to-day function may not be objectively hindered despite self-reported disability. For latissimus dorsi flap reconstruction, patients also report some dysfunction at the donor site, but this does not seem to result in significant, long-lasting limitation of daily activity. Athletic and other vigorous activities are most affected. For abdominal free flaps, patient perception of postoperative disability is generally not significant, despite the varying degrees of objective disadvantage that have been identified depending on the extent of rectus muscle sacrifice. With these functional repercussions in mind, a broader perspective on the attempt to ensure minimal functional decline after breast surgery should focus not only on surgical technique but also on postoperative rehabilitation. Early directed physical therapy may be an instrumental element in facilitating return to baseline function. With the patient’s optimal quality of life as an overarching objective, a multifaceted approach to functional preservation may be the answer to this continued challenge. This review will examine these issues in depth in an effort to better understand postoperative functional outcomes with a focus on the younger, active breast reconstruction patient.
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Affiliation(s)
- Jonas A Nelson
- Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Iris T Lee
- Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Joseph J Disa
- Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pa
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Château J, Boucher F, Braye F, Erhard L, Mojallal A. Reconstruction of soft tissue defects of the distal third of the arm using a muscle-sparing latissimus dorsi musculocutaneous flap. HAND SURGERY & REHABILITATION 2017; 37:16-19. [PMID: 29051048 DOI: 10.1016/j.hansur.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 05/13/2017] [Accepted: 09/13/2017] [Indexed: 11/26/2022]
Abstract
Use of a latissimus dorsi (LD) flap has been widely described for upper limb reconstruction. However, donor site sequelae have led to the development of muscle-sparing techniques for the LD flap. We present the technical principles of a muscle-sparing LD flap and its use as a pedicled flap to reconstruct the distal third of the arm.
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Affiliation(s)
- J Château
- Plastic, reconstructive and aesthetic surgery department, Croix-Rousse hospital, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - F Boucher
- Plastic, reconstructive and aesthetic surgery department, Croix-Rousse hospital, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - F Braye
- Plastic, reconstructive and aesthetic surgery department, Croix-Rousse hospital, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - L Erhard
- Institut chirurgical de la main et du membre supérieur, 19, avenue Condorcet, 69100 Villeurbanne, France
| | - A Mojallal
- Plastic, reconstructive and aesthetic surgery department, Croix-Rousse hospital, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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Abstract
Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.
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Affiliation(s)
| | - Marc G Lubitz
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Sowa Y, Morihara T, Kushida R, Sakaguchi K, Taguchi T, Numajiri T. Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy. Breast Cancer 2016; 24:362-368. [PMID: 27379425 DOI: 10.1007/s12282-016-0711-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT). METHODS Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2 months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6 months, and 1 and 3 years. RESULTS The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2 % and at 3 years postsurgery by 4.7 and 5.7 %. The muscle strength measurements at 3 months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9 % and at 3 years postsurgery by 36.4 and 20.4 %. A significant improvement in these impairments was not observed for 3 years after surgery compared with that at 3 months after surgery. CONCLUSION A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.
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Affiliation(s)
- Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Toru Morihara
- Department of Orthopaedics, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Rehabilitation, University Hospital, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rie Kushida
- Department of Orthopaedics, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Rehabilitation, University Hospital, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koichi Sakaguchi
- Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Eyjolfsdottir H, Haraldsdottir B, Ragnarsdottir M, Asgeirsson KS. A Prospective Analysis on Functional Outcomes Following Extended Latissimus Dorsi Flap Breast Reconstruction. Scand J Surg 2016; 106:152-157. [DOI: 10.1177/1457496916655500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: To prospectively assess the functional effect of using the extended latissimus dorsi flap in immediate breast reconstructions. Materials and Methods: A total of 15 consecutive patients undergoing breast reconstruction with extended latissimus dorsi flap participated. Shoulder range of motion, muscle strength, lateral flexion of the torso, and position of scapula were measured pre-operatively and 1, 6, and 12 months post-operatively, in addition to donor-site post-operative complications. Results: At 12 months post-operatively, patients had achieved full range of shoulder movement, when compared to pre-operative values. Lateral flexion of the torso was, however, significantly reduced bilaterally at 1 and 6 months post-operatively (p = 0.001, p = 0.01) and to the not operated side at 12 months (p = 0.01). Muscle strength in flexion–extension–internal rotation was significantly (p = 0.01) reduced on the operated side 12 months post-operatively. All but one patient had numbness around the donor-site scar 12 months post-operatively, 33% had slight adhesions but all were pain free. Conclusion: Although invariably, patients having extended latissimus dorsi flap may expect to achieve full range of shoulder movement, they should be informed of possible functional consequences and the time and effort it takes to recover. Further research is needed to investigate the potential long-term functional implications that extended latissimus dorsi flap may have as a result of changes in the lateral flexion of the torso and scapula position.
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Affiliation(s)
- H. Eyjolfsdottir
- Department of Physiotherapy, Landspitali—The National University Hospital, Reykjavik, Iceland
| | - B. Haraldsdottir
- Department of Physiotherapy, Landspitali—The National University Hospital, Reykjavik, Iceland
| | - M. Ragnarsdottir
- Department of Physiotherapy, Landspitali—The National University Hospital, Reykjavik, Iceland
| | - K. S. Asgeirsson
- Department of Surgery, Landspitali—The National University Hospital, Reykjavik, Iceland
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van Huizum MA, Hoornweg MJ, de Ruiter N, Oudenhoven E, Hage JJ, Veeger DJ. Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity. J Plast Surg Hand Surg 2016; 50:202-7. [PMID: 27046453 DOI: 10.3109/2000656x.2016.1151436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Dissection of the latissimus dorsi (LD) flap may have a distinct impact on upper extremity function and strength. To date, insufficient differentiation has been made between loss of muscular strength and shoulder function by dissection of the LD muscle per se and loss of function resulting from all excisional surgery, radiation therapy, and reconstructive procedures at the donor site and the recipient site that may have been combined near the shoulder region. METHODS This study determines the long-term effect of the LD breast reconstruction on the strength profiles of the upper extremity by measuring the isometric torque strength both in seven synergistic- and two contra-movement directions. The Biodex System 3 Pro (Biodex Medical Systems, New York, NY) was used in 12 patients at a mean of 3.5 years after surgery, and in 20 matched controls. Because loss of LD muscle may not result in significant impairment of activities of daily live (ADL) even in cases where objective measurements are decreased, this study simultaneously assessed the subjective function by use of the standardised Disability of Arm, Shoulder and Hand (DASH) questionnaire. RESULTS This study observed a significant long-term loss of 8.8 Nm or 19% LD torque strength in synergistic movement directions after transplantation of the LD muscle. This loss correlated significantly with an increase of the mean DASH score among the patients. CONCLUSIONS Because no significant loss of contra-movement torque strength was observed, it was concluded that the loss of synergistic torque strength appears to result from the loss of LD function per se.
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Affiliation(s)
- Martine A van Huizum
- a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Marije J Hoornweg
- a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Noor de Ruiter
- b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands
| | - Erik Oudenhoven
- b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands
| | - J Joris Hage
- a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Dirk Jan Veeger
- b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands
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19
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Garusi C, Manconi A, Lanni G, Lomeo G, Loschi P, Simoncini MC, Santoro L, Rietjens M, Petit JY. Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study - Combining DASH score and objective evaluation. Breast 2016; 27:78-86. [PMID: 27054752 DOI: 10.1016/j.breast.2016.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. MATERIALS AND METHODS We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011. RESULTS The majority of patients showed a joint recovery superior to 80% in all joint movements examined. Disabilities of the Arm, Shoulder and Hand questionnaire revealed minimal disability similar to normal range and furthermore it appears to decrease in all sports and in particular in those who practice with LD involvement. CONCLUSION Focusing this data, a growing, "disability-free" percentage changes depending on whether or not the patients have practiced sport could be appreciate.
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Affiliation(s)
- C Garusi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - A Manconi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - G Lanni
- Division of Physical Therapist, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - G Lomeo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - P Loschi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - M C Simoncini
- Division of Physical Therapist, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - L Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - M Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - J Y Petit
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Dast S, Assaf N, Dessena L, Almousawi H, Herlin C, Berna P, Sinna R. Change of paradigm in thoracic radionecrosis management. ANN CHIR PLAST ESTH 2016; 61:200-5. [PMID: 26831037 DOI: 10.1016/j.anplas.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/19/2015] [Indexed: 11/26/2022]
Abstract
Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.
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Affiliation(s)
- S Dast
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - N Assaf
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - L Dessena
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - H Almousawi
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - C Herlin
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - P Berna
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France
| | - R Sinna
- Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
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Nishida Y, Tsukushi S, Urakawa H, Toriyama K, Kamei Y, Yokoi K, Ishiguro N. Post-operative pulmonary and shoulder function after sternal reconstruction for patients with chest wall sarcomas. Int J Clin Oncol 2015; 20:1218-25. [PMID: 25981950 DOI: 10.1007/s10147-015-0844-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sternal resection is occasionally required for patients with malignant tumors, particularly sarcomas, in the sternal region. Few reports have described post-operative respiratory and shoulder function after sternal resection for patients with bone and soft-tissue sarcomas. METHODS Eight consecutive patients with bone and soft tissue sarcomas requiring sternal resection were the focus of this study. Chest wall was reconstructed with a non-rigid or semi-rigid prosthesis combined, in most cases, with soft tissue flap reconstruction. Clinical outcomes investigated included complications, shoulder function, evaluated with Musculoskeletal Tumor Society-International Symposium of Limb Salvage system, and respiratory function, evaluated by use of spirometry. RESULTS The anterior chest wall was reconstructed with non-rigid strings for 3 patients and with polypropylene mesh for 5. There were no severe post-operative complications, for example surgical site infection or pneumonia. All 3 patients with non-rigid reconstruction experienced paradoxical breathing, whereas none with polypropylene mesh did so. Post-operatively, FEV(1)% was unchanged but %VC was significantly reduced (p = 0.01), irrespective of the reconstruction method used (strings or polypropylene mesh). Shoulder function was not impaired. CONCLUSIONS Among patients undergoing sternal resection, post-operative shoulder function was excellent. Pulmonary function was slightly restricted, but not sufficiently so to interfere with the activities of daily living (ADL). Paradoxical breathing is a slight concern for non-rigid reconstruction.
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Affiliation(s)
- Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kazuhiro Toriyama
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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Schneider LF, Mehrara BJ. De-mythifying breast reconstruction: a review of common misconceptions about breast reconstruction. J Am Coll Surg 2015; 220:353-61. [PMID: 25600975 DOI: 10.1016/j.jamcollsurg.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa F Schneider
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, NJ.
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Memorial Sloan Kettering Hospital, New York, NY
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Séquelles du prélèvement du lambeau de grand dorsal et ses dérivés – Revue de la littérature. ANN CHIR PLAST ESTH 2014; 59:348-54. [DOI: 10.1016/j.anplas.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 05/08/2014] [Indexed: 11/20/2022]
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24
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A Systematic Review of Functional Donor-Site Morbidity after Latissimus Dorsi Muscle Transfer. Plast Reconstr Surg 2014; 134:303-314. [DOI: 10.1097/prs.0000000000000365] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Muramatsu K, Ihara K, Tominaga Y, Hashimoto T, Taguchi T. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthet Surg 2014; 67:916-20. [DOI: 10.1016/j.bjps.2014.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/01/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
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Boughebri O, Kilinc A, Valenti P. Reverse shoulder arthroplasty combined with a latissimus dorsi and teres major transfer for a deficit of both active elevation and external rotation. Results of 15 cases with a minimum of 2-year follow-up. Orthop Traumatol Surg Res 2013; 99:131-7. [PMID: 23510632 DOI: 10.1016/j.otsr.2012.11.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 10/16/2012] [Accepted: 11/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Our aim was to assess the clinical and radiological outcomes of reverse shoulder replacements performed in association with a latissimus dorsi and teres major tendon transfer in cases of irreparable posterosuperior cuff tears including the teres minor tendon. Our hypothesis was that the tendon transfers would improve the clinical results of arthroplasty by restoring active external rotation. METHODS Fifteen procedures in 14 patients were performed through a single deltopectoral approach. Both tendons were fixed to the proximal anterolateral aspect of the humeral metaphysis. Mean age at the time of surgery was 67.5 years (range 53 to 82 years). All had severe cuff tear arthropathy (Hamada stage 3 or 4) and severe atrophy or fatty infiltration of the infraspinatus and teres minor on preoperative MRI or CT-scan (Goutallier stage 3 or 4). Preoperative and postoperative functions were assessed by Constant score. Satisfaction was assessed by the Simple Shoulder Test (SST). At follow up, radiographs were examined for radiolucent lines, osteolysis and scapular notching. RESULTS The average follow-up after surgery was 33.2 months (range 24 to 60 months). The mean absolute Constant score improved significantly (P=10(-5)) from 23.7±11.5 preoperatively to 61.1±11.9 postoperatively. Forward flexion and external rotation with the arm at the side improved significantly, respectively from 64.7±35.6° preoperatively to 126±34.4° postoperatively (P<10(-5)) and from -8.7±21.3° to 27.3±12.2° (P<0.0005). Internal rotation was not affected. The mean SST improved from 1.9±1.6 points preoperatively to 7.6±1.8 points postoperatively (P<0.0005). Twelve patients were very satisfied or satisfied (including one with a bilateral procedure) and 2 were unsatisfied with the final result. At final follow-up, radiographs showed no radiolucent lines around the implants nor scapular notching. CONCLUSION The combined procedure helped restoration of active elevation and external rotation in cases of massive cuff tear including the teres minor tendon. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- O Boughebri
- Department of Orthopaedic Surgery and Sports Trauma, hôpital privé Armand-Brillard, 3, avenue Watteau, 94130 Nogent-sur-Marne , France.
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Kolegraff K, Moosavi B, Losken A. Current Considerations for Breast Reconstruction in Breast Cancer Patients. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-012-0033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Netscher DT, Izaddoost S, Sandvall B. Complications, pitfalls, and outcomes after chest wall reconstruction. Semin Plast Surg 2012; 25:86-97. [PMID: 22294947 DOI: 10.1055/s-0031-1275175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chest wall and mediastinal wounds may be life-threatening. Although modern reconstruction methods with various muscle flaps have reduced morbidity and mortality, chest wall reconstruction presents unique challenges. Major categories of adverse outcomes include (1) persistent infection; (2) interference with respiratory mechanics; (3) functional deficits of the shoulder; and (4) hernias. Persistent infection may be resolved by providing coverage via muscle or omental flap, performing thorough debridement, filling the "dead space" with adequate volume, buttressing repair of visceral fistulae, and covering exposed prosthetic material with vascularized flaps. Potential deficits in respiratory mechanics and shoulder function may be avoided by stabilizing the chest wall skeleton and decreasing donor muscle functional loss. Hernias may be minimized by maintaining visceral "right of domain" to the chest and abdominal cavities. Complex reconstructive cases represent an intricate interplay of physiology, structural protection, and aesthetic considerations and require integration of several management principles.
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Affiliation(s)
- David T Netscher
- Department of Orthopedic Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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29
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Functional neuro-vascularized muscle transfer for oncological reconstruction of extremity sarcoma. Surg Oncol 2012; 21:263-8. [PMID: 22835825 DOI: 10.1016/j.suronc.2012.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/05/2012] [Accepted: 06/23/2012] [Indexed: 11/23/2022]
Abstract
The strategy of limb salvage following surgical resection of skeletal tumor has led to an increased demand for more complex reconstructive options in order to achieve better functional outcomes. Functional neuro-vascularized muscle transfer (FMT) is a beneficial tool for restoring joint movement involving the reconstruction of "movement" in the affected extremity. Until now, however, the clinical application of FMT was mainly limited to trauma cases and to date, very few studies have focused on musculoskeletal oncology. In this study, we reviewed patients who underwent wide resection for extremity sarcoma and functional reconstruction using FMT and discussed the advantages, indications and complications of the procedure.
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Izadi D, Paget JTEH, Haj-Basheer M, Khan UM. Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconstr Aesthet Surg 2012; 65:1357-62. [PMID: 22652284 DOI: 10.1016/j.bjps.2012.04.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 04/06/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The scapular, parascapular and thoracodorsal artery perforator (TDAP) flaps represent fasciocutaneous flaps derived from the subscapular artery axis. These flaps can be harvested individually or combined as conjoint flaps, tailored to reconstruct a wide variety of defects in the extremities. ANALYSIS AND METHODS: All patients undergoing free-flap reconstruction at North Bristol trust with a fasciocutaneous flap of the subscapular axis from April 2006 until April 2010 were included. This cohort of 45 patients was retrospectively analysed. The Enneking score for return of limb function was used as an outcome measure after reconstruction. Donor-site morbidity analysis was carried out prospectively using Oxford Medical Research Council (MRC) score, Vancouver Scar Scale and disability of arm, shoulder and hand questionnaire (DASH) scores. RESULTS A total of 45 patients had extremity reconstruction using flaps of the subscapular artery axis following severe limb trauma, often comprising open tibial fractures. A total of 42 patients had lower limb injuries and three had upper limb injuries. All flaps survived. The mean Injury Severity Score (ISS) was 9.3, the mean Enneking score was 27 at 12 months mean follow-up. In the nine conjoint flaps, the mean area of tissue resurfaced was 257 cm2. CONCLUSIONS In this case series of fasciocutaneous flaps of the subscapular artery axis, we establish that these flaps are robust and versatile. They replace 'like-with-like' and have good patient satisfaction. The donor site can be closed primarily, is discrete and has minimal donor morbidity. The conjoint flaps can be used for reconstruction of very large defects without the need to sacrifice functionally important muscle.
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Affiliation(s)
- David Izadi
- Department of Plastic and Reconstructive surgery, Frenchay Hospital, Frenchay, Bristol BS16 1LE, UK
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31
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Lutringer J, Flipo B, Carles M, Gal J, Chignon-Sicard B. [Functional impairment and its impact on sporting activities after latissimus dorsi flap breast reconstruction]. ANN CHIR PLAST ESTH 2012; 57:567-74. [PMID: 22633659 DOI: 10.1016/j.anplas.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
AIM OF THE STUDY The latissimus dorsi flap is commonly used for breast reconstruction. Donor site morbidity is the major side effect of this surgery. However, if the impact of the latissimus dorsi muscle removal on daily living activities has already been studied, few data are available about its consequences on sporting activities. MATERIAL AND METHOD Our retrospective monocentric study reviewed 75 consecutive female patients who underwent latissimus dorsi muscle transfer for breast reconstruction with a mean follow-up of 32.4 months. Patients had to answer a questionnaire per phone about their sporting, daily living and working activities before and after surgery. If they felt any changes after surgery, the type of limitation was detailed (pain, strength, endurance). RESULTS We showed a reduction in sporting activities for 43% patients practising a sport using the upper limb compared to 19% for them using the lower limb (P<0.05%). Eighty-three percent of the patients felt restricted for at less one activity of daily living. 5.2% had to adapt their working conditions after surgery. CONCLUSION The reduction in sporting activities using the upper limb after surgery suggests a negative impact of the surgery. However, other factors than the latissimus dorsi muscle removal might contribute to this reduction.
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Affiliation(s)
- J Lutringer
- Service de chirurgie sénologique, centre Antoine-Lacassagne, Nice, France.
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Bonomi S, Settembrini F, Salval A, Gregorelli C, Musumarra G, Rapisarda V. Current indications for and comparative analysis of three different types of latissimus dorsi flaps. Aesthet Surg J 2012; 32:294-302. [PMID: 22395320 DOI: 10.1177/1090820x12437783] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Free tissue transfer with lower abdominal flaps for autologous breast reconstruction is not suitable for all patients. The latissimus dorsi (LD) musculocutaneous flap is an alternative, effective method for both immediate and delayed breast reconstruction. OBJECTIVES The authors assess their experience with LD flaps for breast reconstruction, including indications for patient selection, donor site choice, aesthetic outcomes, complications, and patient satisfaction. METHODS Charts for all patients who underwent breast reconstruction with one of three types of LD myocutaneous flaps during a three-year period at a single institution were retrospectively reviewed. Patients (n = 82) were divided into three groups: (1) 35 patients received a standard LD myocutaneous flap with implant, (2) 18 patients underwent a muscle sparing LD flap procedure with implant, and (3) 29 patients had an autologous LD flap. A questionnaire was administered to assess flap and donor site complications, aesthetic outcomes, patient satisfaction, and shoulder function. RESULTS Flap complications occurred in 13 patients (15%). Donor site complications occurred in 24 patients (28%), mostly consisting of back seroma with the autologous LD flap. There was no significant difference in shoulder range of motion or muscle strength between the operated and unoperated sides. Patient satisfaction was high in all three study groups. CONCLUSIONS The LD is a safe, versatile, and reproducible technique for breast reconstruction. The procedure benefits from ease of flap harvesting and setting and may provide satisfactory results in diverse patients, including those for whom an abdominal flap is neither indicated nor feasible. .
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Affiliation(s)
- Stefano Bonomi
- Department of Plastic Reconstructive Surgery and Burn Unit Center, Ospedale Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy.
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Giordano S, Kääriäinen M, Alavaikko J, Kaistila T, Kuokkanen H. Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run. Scand J Surg 2011; 100:202-207. [DOI: 10.1177/145749691110000312] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: The latissimus dorsi (LD) muscle or myocutaneous flap is one of the most commonly used flaps and is believed to result in minimal donor-side morbidity. The impact on shoulder function from LD removal is important due to the common nature of this procedure. Previous studies have been performed after relatively short follow-up time and mostly after breast reconstruction. The purpose of this study was to objectively evaluate shoulder function years after latissimus dorsi muscle free flap operation. Methods: Between 1998 and 2004, eight patients who underwent LD-free flap for lower limb (7) or head and neck (1) soft tissue reconstruction were enrolled in this study. Scar, shoulder pain, function, mobility, stability and strength were evaluated and measured by using the Patient Scar Assessment Questionnaire (PSAQ), the Scar Evaluation Scale (SES) score, the American Shoulder and Elbow Surgeons (ASES) form, goniometer and isokinetic tests. Measurements of the operated sides were compared to the non-operated sides. Results: Mean age was 54 ± 21 years and mean follow-up was 92.5 ± 36 months after surgery. Mean PSAQ was 73 (65%), mean SES score was 2 ± 1. When comparing the operated sides to the unoperated sides, ASES score was significantly lower in the operated side (76 versus 93, p = 0.008); The range of motion in active and passive endorotation, active extrarotation and active forward elevation were significantly reduced after surgery. Operated side revealed a significant joint instability (3.6 versus 1.2, p = 0.007) using the ASES form. Isokinetic tests revealed that only intra-rotation strength was significantly reduced (35.74 Newton-metre versus 42.7 Newton-metre, p = 0.03) in the operated side. Conclusion: LD harvesting can affect the function of the shoulder joint in the long run. Reduced mobility, instability and weakness could be obtained with objective measurements. However, the results should be interpreted with caution because of the small sample size, internal controls and retrospective nature of this study.
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Affiliation(s)
- S. Giordano
- Department of Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - M. Kääriäinen
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - J. Alavaikko
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - T. Kaistila
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - H. Kuokkanen
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
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Kim JT, Ng SW, Kim YH. Application of various compositions of thoracodorsal perforator flap for craniofacial contour deformities. J Plast Reconstr Aesthet Surg 2011; 64:902-10. [DOI: 10.1016/j.bjps.2010.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/19/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
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Shoulder and upper arm muscle architecture. J Hand Surg Am 2011; 36:881-9. [PMID: 21527142 DOI: 10.1016/j.jhsa.2011.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 01/08/2011] [Accepted: 01/11/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the architecture of the shoulder and upper arm muscles and generate data that could serve as a guide for comparison, compatibility, and relative performance among these muscles for use in transfer. METHOD Eleven shoulder and arm muscles were dissected bilaterally in 5 fresh cadavers. Of these 110 potentially available muscles, 107 were suitable for evaluation and were grouped according to similarities in architecture. Resting muscle length, required excursion, muscle fiber length, pennation angle, and mass were determined. Physiologic cross-sectional area (PCSA) was then calculated from these parameters using a standard formula. RESULTS Based on the gross appearance of muscle fiber orientation, the 11 muscles were subdivided into 3 groups. Required excursion was found to be less than fiber length in all muscles except for the teres major and middle deltoid with abduction. The middle deltoid muscle was found to have a short fiber length, complex multipennate structure, and high PCSA. Comparison showed the biceps and posterior deltoid to have fiber lengths greater than any portion of the triceps; however, neither demonstrated architectural features that would generate the force (represented by PCSA) determined for the combined triceps. CONCLUSIONS Data presented in this study offer the opportunity for direct comparison of architectural features of select shoulder and arm musculature.
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Muramatsu K, Ihara K, Miyoshi T, Yoshida K, Hashimoto T, Taguchi T. Transfer of latissimus dorsi muscle for the functional reconstruction of quadriceps femoris muscle following oncological resection of sarcoma in the thigh. J Plast Reconstr Aesthet Surg 2011; 64:1068-74. [PMID: 21474401 DOI: 10.1016/j.bjps.2011.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 02/17/2011] [Accepted: 03/03/2011] [Indexed: 11/16/2022]
Abstract
Wide resection of tumours in the anterior compartment of the thigh frequently requires en bloc removal of the quadriceps femoris muscle. Such resection can result in significantly decreased muscle power of knee extension. Functional muscle transfer is a beneficial tool for the reconstruction process. Until now, however, there have been few reports on the outcome of quadriceps muscle reconstruction using free innervated muscle transfer. We reviewed 14 patients (seven women and seven men, mean age 53 years). The extent of tumour invasion required resection of the entire quadriceps in four cases, of three heads in six cases and of two heads in the remaining four cases. Local recurrence occurred in one patient only, and there were no major complications. In the four patients with entire resection of the quadriceps, the postoperative muscle manual test (MMT) result was 0-1 (mean, 0.5), but this recovered to between 2 and 3 (mean 2.3) after a mean follow-up of 70 months. In the six cases with resection of three heads, the MMT test result was 2 and active knee extension recovered almost fully. Transfer of free, functional latissimus dorsi muscle is best indicated for cases in which the entire quadriceps or three heads are resected. Active knee extension can be expected to improve to an MMT score of 2 after reinnervation of the transferred muscle. Microsurgical reconstruction following resection of soft-tissue sarcoma provides adequate functional and coverage reconstruction, together with better local control by allowing wider surgical margins.
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Affiliation(s)
- K Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube,Yamaguchi 755-8505, Japan.
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Forthomme B, Heymans O, Jacquemin D, Klinkenberg S, Hoffmann S, Grandjean FX, Crielaard JM, Croisier JL. Shoulder function after latissimus dorsi transfer in breast reconstruction. Clin Physiol Funct Imaging 2011; 30:406-12. [PMID: 20633032 DOI: 10.1111/j.1475-097x.2010.00956.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Latissimus dorsi (LD) transfer in the case of breast reconstruction remains frequently used because this muscle provides a good size source of tissue in reconstructive surgery. Given that, the consequences of the LD removal on shoulder function and the actual loss of maximal strength developed must be investigated. METHODS Twenty women (50 ± 7.5 years old) were evaluated before surgery, 3 and 6 months after an unilateral transfer of a pedicle flap of LD muscle used for breast reconstruction. Women performed a bilateral shoulder isokinetic assessment [for the internal rotators (IRs) and external rotators and for the abductor and adductor (ADD) muscles] allowing the establishment of bilateral muscular deficit status and the study of agonist/antagonist muscle ratios. The algofunctional and clinical status of the shoulders was analysed by the means of Constant score and specific shoulder clinical tests. The women did not perform any specific strengthening of muscle shoulder after surgery. RESULTS The isokinetic assessment showed a muscle weakness 3 and 6 months after LD transfer, mainly on the ADDs (33 ± 9% at 6 months) and on the IRs (16 ± 11% at 6 months). The Constant score significantly decreased after surgery on the operated shoulder. Women with a Constant score impairment showed pain during specific shoulder clinical tests. We also found a correlation between Constant score impairment and internal rotators weakness or rotator muscle imbalance. CONCLUSION Given those results, we could advocate a specific shoulder strengthening after LD transfer, focused mainly on the IRs and ADDs.
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Affiliation(s)
- B Forthomme
- Department of Motricity Sciences, University and CHU of Liege Service of Plastic Surgery, University and CHU of Liege, Liege, Belgium.
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Zakaria Y, Hasan EA. Reversed turnover latissimus dorsi muscle flap for closure of large myelomeningocele defects. J Plast Reconstr Aesthet Surg 2010; 63:1513-8. [DOI: 10.1016/j.bjps.2009.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/31/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Button J, Scott J, Taghizadeh R, Weiler-Mithoff E, Hart A. Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg 2010; 63:1505-12. [DOI: 10.1016/j.bjps.2009.08.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 08/12/2009] [Accepted: 08/13/2009] [Indexed: 11/25/2022]
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Outcomes Evaluation Following Bilateral Breast Reconstruction Using Latissimus Dorsi Myocutaneous Flaps. Ann Plast Surg 2010; 65:17-22. [DOI: 10.1097/sap.0b013e3181bda349] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An Algorithmic Approach to Breast Reconstruction Using Latissimus Dorsi Myocutaneous Flaps. Plast Reconstr Surg 2010; 125:1318-1327. [DOI: 10.1097/prs.0b013e3181d6e7b8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chest reconstruction: I. Anterior and anterolateral chest wall and wounds affecting respiratory function. Plast Reconstr Surg 2010; 124:240e-252e. [PMID: 20009799 DOI: 10.1097/prs.0b013e3181b98c9c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the indications for chest wall reconstruction. 2. Understand the function of the chest wall and implications for both reconstruction and the chest wall itself when components are missing or used for reconstruction. 3. List the reconstructive requirements of chest wall wounds. 4. Identify flaps for regional reconstruction of the chest wall. 5. Describe the role of microvascular surgery in chest wall reconstruction. BACKGROUND Chest wall and mediastinum wounds may be life-threatening. They interfere with respiratory mechanics and may also be contaminated with exposed vital structures. Consideration is given to flap choice to restore function, resolve infection, and maintain suitable aesthetics. METHODS Literature search as well as the authors' personal experience enabled preparation of this article. RESULTS Where necessary, skeletal integrity must be restored, generally with prosthetic material, and then covered with well-vascularized soft tissue. "Living tissue" is required to help combat infection, buttress visceral repairs, and fill dead space. Soft-tissue deficiency must occasionally be augmented with large distant microvascular flaps. CONCLUSION Flap reconstruction has reduced morbidity and mortality of these complex problems without undue donor-site impairment of respiratory and upper extremity function.
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Berdah-Benjoar Y, Masson J, Revol M, Servant JM. Résultats à long terme des reconstructions mammaires par lambeau de grand dorsal et prothèse. ANN CHIR PLAST ESTH 2009; 54:295-302. [DOI: 10.1016/j.anplas.2008.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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Innocenti M, Abed YY, Beltrami G, Delcroix L, Balatri A, Capanna R. Quadriceps muscle reconstruction with free functioning latissimus dorsi muscle flap after oncological resection. Microsurgery 2009; 29:189-98. [PMID: 19097058 DOI: 10.1002/micr.20607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The concept of limb salvage led to increased demand for more complex and sophisticated reconstructive options to achieve better functional and cosmetic outcome. Reconstruction of the total or partial loss of quadriceps muscle after soft tissue sarcomas excision with free functioning latissimus dorsi muscle transfer had become more popular in the last years. PATIENTS AND METHODS Between November 1993 and October 2004, 11 patients with average age 45.5 years underwent excision of quadriceps muscle followed by simultaneous reconstruction with free functioning latissimus dorsi muscle. There were six men and five women. The tumors were high grade in 90.9% of patients and were >10 cm in 81.8% of patients. The tumor extension required the resection of the entire quadriceps in four cases, of three heads in six cases, of only two heads in one case. RESULTS The average follow up was 69 months. The average time of recovery of the contractile activity of the muscle was 8.3 months after operation. The musculoskeletal tumor society rating score (MTSRS) scored excellent or good in 73% of patients. Three patients (27.3%) died of metastatic disease. Local recurrence occurred in one patient (9.1%). Limb salvage was achieved in all the patients (100%). CONCLUSION This method of reconstruction is a reliable technique not only to fill the defect resulting from oncological resection but also to provide better function. Microsurgical reconstruction of soft tissue sarcoma helps to expand the indications of limb salvage by allowing better local control and achieving adequate function and coverage.
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Affiliation(s)
- Marco Innocenti
- Department of Orthopaedics, Reconstructive Microsurgery Unit, Azienda Ospedaliera Careggi, C.T.O., Florence, Italy.
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Saint-Cyr M, Nagarkar P, Schaverien M, Dauwe P, Wong C, Rohrich RJ. The pedicled descending branch muscle-sparing latissimus dorsi flap for breast reconstruction. Plast Reconstr Surg 2009; 123:13-24. [PMID: 19116510 DOI: 10.1097/prs.0b013e3181934838] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely oriented skin paddle presents distinct advantages in breast reconstruction, including reduced donor-site morbidity and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, complications, and aesthetic and functional outcomes following use of this flap for breast reconstruction. METHODS A retrospective study of 20 patients who underwent breast reconstruction with a pedicled muscle-sparing latissimus dorsi musculocutaneous flap was conducted. Indications for surgery included breast reconstruction following mastectomy, lumpectomy, and irradiation, and for correction of implant-related complications. Case-note review was performed, as was a functional evaluation consisting of a patient questionnaire, a Disabilities of the Arm, Shoulder, and Hand form, postoperative range-of-motion analysis, and instrumented strength testing comparing the operated and nonoperated sides. Aesthetic evaluation of the donor site was conducted by all patients. An anatomical study of 15 flaps harvested from fresh cadavers was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch. RESULTS Twenty-four descending branch muscle-sparing latissimus dorsi flaps were harvested. All donor sites were closed primarily, with skin paddle sizes ranging up to 25 x 12 cm. There was one case of minor flap tip necrosis and no instances of seroma. There was no statistically significant difference in strength or range of motion of the shoulder joint when comparing the operated to the nonoperated side. Two patients reported minor functional impact following surgery. CONCLUSIONS The pedicled descending branch muscle-sparing latissimus dorsi flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar.
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Affiliation(s)
- Michel Saint-Cyr
- Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
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A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction. Plast Reconstr Surg 2008; 122:1334-1340. [PMID: 18971716 DOI: 10.1097/prs.0b013e3181881ffe] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact on shoulder function from removal of the latissimus dorsi muscle in breast reconstruction is important because of the common nature of this operation. Informed consent requires us to discuss the impact of surgery and likely recovery times. The literature already supports the absence of long-term effects from this procedure. However, all studies and subsequent reviews are based on retrospective studies, thus making it impossible to assess recovery time scales compared with preoperative values. In this prospective study, the authors set out to define the impact on shoulder function and, importantly, to assess recovery time scales compared with preoperative values. METHODS Shoulder range of motion, strength, function, and pain were assessed prospectively in 22 subjects who had latissimus dorsi muscle flap breast reconstruction. Assessments were carried out preoperatively and then at 6 weeks, 6 months, and 1 year postoperatively using standardized objective assessments. RESULTS The results demonstrate no significant loss of range of motion, strength, function, or pain at 1 year. However, strength, disability scores, neural glide, and discomfort were still abnormal at 6 months and then normalized at 1 year. It was noted that the extended latissimus dorsi flap tended to have poorer scores and recovery compared with a latissimus dorsi flap and implant. CONCLUSION The authors believe this information to be important to the patient, therapist, and surgeon in the assessment of postoperative recovery from this procedure.
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Abstract
BACKGROUND Converting the latissimus dorsi musculocutaneous flap to a thoracodorsal artery perforator flap has been reported for breast reconstruction. The goal of this article is to evaluate the donor site after harvesting a thoracodorsal artery perforator flap in patients who underwent breast surgery and to show the advantages of sparing the latissimus dorsi muscle on the function of the shoulder. METHODS Between 2002 and 2004, 22 patients who had a partial breast reconstruction using a pedicled thoracodorsal artery perforator flap were enrolled in a functional study to evaluate shoulder function postoperatively. Latissimus dorsi muscle strength, shoulder mobility, and latissimus dorsi thickness were measured by using the MicroFet2, a goniometer, and ultrasound examination, respectively. The measurements of the operated and contralateral (unoperated) sides were analyzed statistically. RESULTS When comparing the operated sides to the unoperated sides, latissimus dorsi strength seemed to be maintained after surgery. Shoulder mobility was also similar in all movements, but both active and passive forward elevation and passive abduction were reduced significantly after surgery, and latissimus dorsi thickness was not affected by harvesting the thoracodorsal artery perforator flaps. No seroma formation was found in any of the donor sites. CONCLUSIONS Donor-site morbidity after harvesting a thoracodorsal artery perforator flap was reduced to a minimum. Therefore, perforator flaps should be considered in reconstruction whenever adequate perforators can be identified and safely dissected.
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Postmastectomy Reconstruction of the Breast Using the Latissimus Dorsi Musculocutaneous Flap. Cancer J 2008; 14:248-52. [DOI: 10.1097/ppo.0b013e318180bcc2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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