Use of latissimus dorsi pedicled myocutaneous flap for reconstruction in the chest area of an 8-month-old female infant with ectopia cordis.
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ABSTRACT:
SUBMITTER: Dastagir K
PROVIDER: S-EPMC4360673 | biostudies-other | 2014 Dec
REPOSITORIES: biostudies-other
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Project description:Surgical treatment of bronchobiliary fistula (BBF) is difficult. A 47-year-old woman presented with a cough with yellow yielding sputum due to BBF. The patient had the adhesion of the liver, diaphragm, and lung. We performed liver, diaphragm, and lung resections. Patient had a large defect of diaphragm. Diaphragm reconstruction was performed using a pedicled reverse latissimus dorsi muscle flap. No flap necrosis was observed. Seven months after surgery, the patient did not present yellow yielding sputum and the BBF was not observed in the computed tomography. This surgical procedure was useful for treating the diaphragm defect both safely and easily. We believe that the reverse pedicled latissimus dorsi muscle flap is a reliable alternative for large diaphragm reconstruction after severe BBF.
| S-EPMC7722541 | biostudies-literature
Project description:BACKGROUND:Using the Latissimus dorsi (LD) muscle flap is one of the popular surgical technique for breast reconstruction. However, usually, long postoperative scar was remained on donor site which does not have disease. The authors applied the endoscopy-assisted surgery to harvest the LD muscle flap for breast reconstruction. METHODS:From July 2018 to July 2019, five consecutive patients with breast cancer underwent partial mastectomy with endoscopy-assisted LD muscle flap reconstruction. The clinic-pathologic factors were analyzed and the cosmetic outcomes were assessed with breast shape, scarring of breast and back. A 4-6?cm of lateral incision (donor site scar) was designed and LD muscle was harvested under endoscopic surgery without gas inflation. And the harvested LD muscle was inserted for partial breast reconstruction after the cancer surgery was done. RESULTS:Mean operative time was 116.4?min (range, 92-134) and there was no major postoperative complication. The satisfactory degree of cosmetic outcomes were shown better in patient's survey than that of surgeon's. CONCLUSIONS:The endoscopy-assisted LD muscle flap harvesting would be useful technique to eliminate a large donor site incision in partial breast reconstruction.
| S-EPMC7450551 | biostudies-literature
Project description:BackgroundFull-thickness burns of the anterior chest wall during childhood are a devastating problem that results in significant distortion of the developing breast. This deformed burnt breast represents a serious aesthetic problem, and can lead to functional impairment as well as severe emotional trauma for patients.MethodsPatients with postburn scarring affecting the lower pole of the breast were included. Only patients with small to medium-sized breasts were targeted. The lower breast pole was reconstructed using muscle-sparing latissimus dorsi flap. All patients had been subjectively assessed, including overall patient satisfaction regarding breast aesthetics, donor site morbidity, and functional deficits of latissimus dorsi muscle, 3 months postoperatively.ResultsSix patients (seven breasts) were included in this study. Muscle-sparing latissimus dorsi flap was used to reconstruct lower breast pole in all patients. A horizontally-oriented skin paddle was used in five patients, whereas a vertically oriented skin paddle was used in one patient. Average patient satisfaction was 9.1 (SD 0.6) for the reconstructed lower breast pole. For the donor site, average overall satisfaction was 9.1 (SD 0.8). Latissimus dorsi muscle function was objectively confirmed in 90% of cases after 3 months postoperatively. Patients had an average score of 3.9 (SD 0.4) for the activity score as well.ConclusionsThe muscle-sparing latissimus dorsi flap is a good reconstructive tool for lower breast pole in postburn breast reconstruction. It has a reliable versatile skin paddle that can resurface the whole lower breast pole, while avoiding many of the latissimus flap morbidities.
| S-EPMC8460227 | biostudies-literature
Project description:Background:This study aimed to evaluate the volume reduction of latissimus dorsi muscle in patients who underwent immediate breast reconstruction using extended latissimus dorsi musculocutaneous (eLDMC) flap with implant after skin/nipple sparing mastectomy (SSM/NSM) and postoperative chemotherapy (POCTx). Methods:We retrospectively reviewed clinical records of 19 patients who underwent this surgery with POCTx, and checked chest computer tomography (CT) at 7-10 days after surgery and 6-14 months after the end of chemotherapy, from May 2015 to October 2016. The motor nerve to latissimus dorsi muscle was severed in all patient. One plastic surgeon intervened and the follow up period was at least 18 months. Author obtained the area of latissimus dorsi muscle using the Picture Archiving and Communication System (PACS) in the axial view of the chest CT and it was verified by the experienced radiologist. The statistical test was performed (P<0.05). Results:There was statistically decrease in latissimus dorsi muscle volume after the end of POCTx, range from 51.5-77.5%, average volume decrease was 62%, compared with latissimus dorsi muscle volume of the CT taken 7-10 days postoperatively (P<0.05). After a minimum follow-up period of 18 months, 14 of the 19 cases were satisfactory for both the surgeon and the patient. In 4 patients, breast volume was symmetrical when wearing bra, but the outline of the 90 cc implant was unfavorable. One patient had a smaller size of reconstructed breast than the other. Conclusions:The size of the implant should be determined considering that average latissimus dorsi muscle reduction is 62%. Especially, the size of the implant should be chosen carefully if latissimus dorsi muscle is thick or it occupies a large portion of the entire flap.
| S-EPMC6842757 | biostudies-literature
Project description:BackgroundMyocutaneous flaps are composed of muscle and fat portions, and exhibit volume changes with time. However, no consideration is generally given to volume changes of muscle and fat portions occurring in the flap. Therefore, we conducted this study to analyze the volume changes of muscle and fat portions of pedicled latissimus dorsi myocutaneous flaps over time.MethodsSixteen patients who underwent breast reconstruction using a latissimus dorsi myocutaneous flap between 2009 and 2017 were enrolled in this study. Using their postoperative computed tomography scan data, we measured the volume of muscle and fat portions of the flap, and performed a statistical analysis of volume changes over time. We also measured the volume of latissimus dorsi muscle on the opposite side and compared the difference in muscle volume.ResultsThe volume of the muscle portion of latissimus dorsi myocutaneous flap decreased by approximately 24%, from 6 months to postoperative year 2; from the third year, it shrank with a decrease rate similar to that of normal muscle. The fat portion of the flap showed no regular volume changes.ConclusionsAtrophy of the muscle portion is the primary cause of volume change of latissimus dorsi myocutaneous flaps over time. it is necessary to understand the difference in the volume change patterns of the muscle and fat. To maintain a long-term satisfactory result, it is better to make the maximum possible use of the relatively stable fat portion rather than the muscle portion.
| S-EPMC8049152 | biostudies-literature
Project description:Autologous breast reconstruction has become a standard option during the recovery of breast cancer survivors. Although pedicle damage is a rare complication of this procedure, extensive torsion or tension can lead to partial or total flap failure. We report a case of partial flap salvage after accidental transection of the pedicled blood supply within the intramuscular course of a latissimus dorsi musculocutaneous flap. This salvage technique involved microvascular anastomosis between the remaining vasculature of the latissimus dorsi pedicle and the serratus branch of the thoracodorsal artery and vein.
| S-EPMC5548585 | biostudies-other
Project description:SUMMARY:Autologous fat grafting is commonly performed in reconstructive breast surgery but also increasingly in breast augmentation surgery. On the international level, we are witnessing an important increased confidence for this procedure. Nevertheless, it continues to raise questions on the risks of cancer. A 66-year-old patient benefited from a lipofilling to improve a latissimus dorsi flap breast reconstruction, 7 years after initial cancer management. Two years later, constant pain in the flap leads to reoperation. The flap showed a major retraction with histologically massive infiltration of the muscle by an undifferentiated carcinoma of breast origin. The tumor cells were displayed directly in contact with lipofilling inside the muscle. Without establishing any causal link between these 2 events, this case raises the question once more of the risks of breast cancer and encourages us to continue being careful.
| S-EPMC4186293 | biostudies-literature
Project description:Robot-assisted surgery is evolving to incorporate a higher number of minimally invasive techniques. There is a growing interest in robotic breast reconstruction that uses autologous tissue. Since a traditional latissimus dorsi (LD) flap leads to a long donor scar, which can be an unpleasant burden to patients, there have been many attempts to decrease the scar length using minimally invasive approaches. This study presents the case of a patient who underwent a robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction with an LD flap using a single-port robotic surgery system. With the assistance of a single-port robot, a simple docking process using a short and less visible incision is possible. Compared to multiport surgery systems, single-port robots can reduce the possibility of collision between robotic arms and provide a clear view of the medial border of the LD where the curvature of the back restricts the visual field. We recommend the use of single-port robots as a minimally invasive approach for harvesting LD flaps.
| S-EPMC8627951 | biostudies-literature
Project description:Large and life-threatening thoracic cage defects can result from the treatment of traumatic injuries, tumors, infection, congenital anomalies, and radiation injury and require prompt reconstruction to restore respiratory function and soft tissue closure. Important factors for consideration are coverage with healthy tissue to heal a wound, the potential alteration in respiratory mechanics created by large extirpations or nonhealing thoracic wounds, and the need for immediate coverage for vital structures. The choice of technique depends on the size and extent of the defect, its location, and donor site availability with consideration to previous thoracic or abdominal operations. The focus of this article is specifically to describe the use of the pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps for reconstruction of thoracic defects, as these are the workhorse flaps commonly used for chest wall reconstruction.
| S-EPMC3140231 | biostudies-other
Project description:Reconstruction of the lower lumbar region is challenging for surgeons due to limited locoregional flap choices. The latissimus dorsi muscle flap is a mainstay for this area; however, there are several limitations, including that the dominant thoracodorsal artery and vein pedicle-based flaps are not reachable for reconstruction of the lumbar region, while perforator of intercostal artery and veins pedicle-based reverse latissimus dorsi (RLD) flap mobility is limited by including multiple perforators. Here, we describe a novel operative technique that lengthens the rotation arc of RLD muscle flaps. The surgical technique is as follows: RLD is elevated based on lower perforator of intercostal artery and veins (usually including two of the eighth-11th perforators); thoracodorsal artery and vein are ligated; and the flap is mobilized toward the defect. When RLD was not reachable to the defect, the far aspect of the intercostal artery and vein from the defect was ligated and the perforator was elevated with the near aspect of the intercostal artery and vein from intercostal space. Because the intercostal space measured between approximately 3 cm and 4 cm, this dissection gained 3-4 cm of rotational arc per intercostal space. Moreover, because the lower ribs follow a medio-cranial to latero-caudal direction, this dissection enabled the flap to extend latero-caudally or medio-cranially while maintaining its blood supply. Other applications using this technique may involve expanding the RLD flap arc caudally, ventrally, and ipsilaterally. We believe this new technique provides a reliable alternative for lower back reconstruction.
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