Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

Background Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. Methods A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. Results The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. Conclusions The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

Reconstruction of hook grip function of the fingers in patients with traumatic brachial plexus injury

We described a reconstruction method for restoring hook grip function of the fingers in patients with total brachial plexus injury. The paralysed latissimus dorsi muscle was transferred to the upper limb as a pedicle flap and sutured to the flexor digitorum profundus tendons. The muscle was then reanimated with two intercostal donor nerves to the thoraco-dorsal nerve. Fourteen young adult patients (mean 23 years, range 17 to 32 years) with traumatic brachial plexus injury who underwent reconstruction using this technique from 2000 to 2019. After mean follow-up of 65 months (range 20 to 170), finger flexion of strength greater than or equal to M3 was achieved in 10 of the 14 patients. The mean weight that could be lifted using a hook grip was 2.6 kg, and that which could be lifted with both hands was 4.1 kg. The intercostal nerve-innervated latissimus dorsi muscle transfer can provide useful hook grip hand function without the need to sacrifice donor vessels or healthy muscles. Level of evidence: IV

The Flap Based on the Subscapular Artery: A Cross-sectional Study

Background: The lateral thoracic-lumbar-scapular region is an ideal source to supply flaps. The study towards improving the method of taking flaps towards conserving a part of the muscle needs to clarify the ratio of branching forms of the arteries in the muscle. Objectives: This study was done to describe the typical anatomy, the anatomical and size variations of subscapular and circumflex scapular vessels, the branching and distribution of vascular pedicle supplying latissimus dorsi muscle flap, and serratus anterior muscle flap of circumflex scapular vessels. Methods: We conducted a cross-sectional study on 24 corpses of adults of both genders. The flap vessels were revealed through two stages of surgery, including the axillary region and the lumbar-scapular region. We classified the collected information and recognized typical and transformed forms based on statistical data. Results: The subscapular artery was separated by the axillary artery, the general origin of the circumflex scapular artery, and the thoracodorsal artery. Subscapular vessels were found in 40/42 cases, accounting for 95.2%, and the length and diameter were 3.04 ± 0.51 cm and 2.85 ± 0.46mm, respectively. The circumflex scapular artery, which had originated from the subscapular artery, was found in 40/42 cases. It also showed origin from subscapular artery with 2/42 cases. The length of the circumflex scapular artery was 3.14 ± 0.70 cm, and its diameter was 2.46 ± 0.48 mm. Terminal branches of the circumflex scapular artery were very variable. Almost all branching forms of the artery in the latissimus dorsi muscle were external branches, but they might be present or not in internal and recurrent branches. Conclusions: The vascular pedicle’s distribution, size, and presence were influenced by the subscapular artery supply flaps. Due to the diverse blood supply from the flaps’ vessels, the surgeon can use the flaps based on the subscapular artery in many forms. These flaps could be used as a seamless vascular flap or a free flap in orthopedic surgery.

Latissimus Dorsi Muscle Flap Transfer Through Endoscopic Approach Combined With the Implant After Tissue Expansion for Breast Reconstruction of Mastectomy Patients

Background: The increasing demand for breast reconstruction and good outcomes lead plastic surgeons to look for a new method to obtain more natural and aesthetically pleasing appearance of the reconstructed breasts.Methods: A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the symmetry of bilateral breasts.Results: The mean endoscopic LDMF harvest time was 90.4 minutes (70.0~120.0 min). The average drain time after the final reconstruction was 10.1 days (6~19 days). In the mean follow-up of 11.2 months (6~28 months), there were no postoperative complications noted. The average post–reconstruction breasts asymmetry was 4.8%±2.4%, the reconstructed side achieved good volume symmetry to the contralateral side (P=0.256).Conclusions: The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, shorten the LDMF harvest time and reduce the incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

EMG Analysis of Dominant and Non-Dominant Arm of Latissimus Dorsi Muscles in Bowlers of Karad, Maharashtra, India

BACKGROUND Latissimus dorsi plays an important role in bowlers. Different bowling techniques recruit latissimus dorsi at different phases of bowling. This causes the muscle to undergo excessive contraction than its limit. Despite widespread knowledge about the recruitment of latissimus dorsi in bowling, there is limited electromyographic (EMG) studies about latissimus dorsi. It is necessary to evaluate and document the recruitment of latissimus dorsi in dominant and non-dominant arm in bowlers, which is focused in this study. This study was done to analyse the surface EMG activity of latissimus dorsi muscle in dominant and non-dominant arm during bowling. METHODS A cross-sectional analytical study was carried out among 96 professional cricket bowlers from deluxe cricket club and Yashwanthrao Chavan’s cricket club in Karad. EMG electrodes were applied over the latissimus dorsi muscle and the bowlers were asked to perform the action of bowling. The root mean square (RMS) and mean peak amplitude of the dominant and non-dominant arm were recorded. RESULTS The RMS (12.45 ± 2.84) values and mean peak amplitude (131.77 ± 44.11) of the dominant latissimus dorsi varied significantly from non-dominant muscle (P = 0.0015). Wilcoxon test was utilized for analysis of within group parameters. CONCLUSIONS The result of the present study showed strong evidence to support high recruitment of dominant latissimus dorsi in professional bowlers suggests the changes occurred in the physiological as well as biomechanical muscular structure. KEY WORDS EMG, Dominant, Non-Dominant, Latissimus Dorsi, Fast Bowlers

Recurrent Giant Malignant Phyllodes Tumor of the Breast

Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast. They have a proliferating stromal component that can be graded as benign, borderline, and malignant. In addition, they are associated with an increased risk of local recurrence and distant metastasis. The authors hereby present a case report of a 34-year-old woman with recurrent malignant PT with an increasing aggressiveness. There were two recurrences of giant tumors that consumed the entire right breast, which developed over a three-year period. The final surgical treatment was a total extirpation of the tumor with subsequent plastic reconstruction using a cutaneous flap from the region of the latissimus dorsi muscle. The patient died three months after the last recurrence due to multiorgan failure.