Less is more - retrospective comparison of shoulder strength and range of motion between conventional and muscle-sparing harvesting technique of a latissimus dorsi flap

Endoscopic-Assisted Latissimus Dorsi Muscle Flap for Chest Wall Reconstruction in Poland Syndrome: Clinical Application and Literature Review

BACKGROUND

Poland syndrome is a rare congenital chest wall developmental defect. Traditional reconstruction applies open to harvest of the latissimus dorsi muscle flap, but issues like large incisions and high complication rates exist. Endoscopic-assisted harvest of the latissimus dorsi muscle flap has minimally invasive advantages worth exploring for application in Poland syndrome patients.

METHODS

We retrospectively analyzed the surgical situations of five Poland syndrome patients at our center, and systematically searched the literature, including 31 cases of endoscopic-assisted latissimus dorsi muscle flap reconstruction. Data on surgical complications, postoperative shoulder function scores, aesthetic scores, and patient satisfaction were collected and comprehensively analyzed in combination with literature reports.

RESULTS

Endoscopic surgery had smaller incisions, fewer complications, shorter recovery time, and high patient scar satisfaction. Postoperative aesthetic results were good, but the obtained flap tissue volume was limited. Upper limb function at the donor site was preserved, but there was some degree of strength decline.

CONCLUSIONS

Endoscopic-assisted latissimus dorsi flap surgery (ELDM) allows for clear visualization of the surgical field, reduces complications, minimizes scarring, shortens recovery time, and provides better cosmetic results, making it suitable for young Poland syndrome patients seeking improved aesthetic outcomes.

LEVEL OF EVIDENCE IV

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Advances in Soft Tissue Injuries Associated with Open Fractures

Management of soft tissue injury is a key component in the overall treatment of upper extremity fractures. Hand surgeons must rely on their armamentarium for treating soft tissue deficits for functional outcomes. Understanding the role of fracture fixation and wound adjuncts, including negative pressure wound therapy and dermal regenerative templates, is the keys to success. In addition, detailed knowledge of local and free tissue options is essential for hand reconstruction.

Interdisciplinary Surgical Therapy of Extremity Soft-Tissue Sarcomas: A Personalized Resection and Reconstruction Algorithm

Soft-tissue sarcomas (STS) are rare, but potentially life-threatening malignancies. STS can occur anywhere in the human body with the limbs being the most common site. Referral to a specialized sarcoma center is crucial to guarantee prompt and appropriate treatment. STS treatment strategies should be discussed in an interdisciplinary tumor board to involve expertise from all available resources, including an experienced reconstructive surgeon for an optimal outcome. In many cases, extensive resection is needed to achieve R0 resection, resulting in large defects after surgery. Hence, an evaluation of whether plastic reconstruction might be required is mandatory to avoid complications due to insufficient primary wound closure. In this retrospective observational study, we present data of patients with extremity STS treated at the Sarcoma Center, University Hospital Erlangen, in 2021. We found that complications were more frequent in patients who received secondary flap reconstruction after insufficient primary wound closure compared to patients who received primary flap reconstruction. Additionally, we propose an algorithm for an interdisciplinary surgical therapy of soft-tissue sarcomas regarding resection and reconstruction and present two problematic cases to emphasize the complexity of surgical sarcoma therapy.

Usefulness of nerve-sparing pedicled segmental latissimus dorsi muscle flap combined with lateral thoracic skin flap for partial volume reconstruction in laterally located breast cancer

Background

The latissimus dorsi muscle (LDM) is a flexible muscle that is frequently employed in various reconstructive operations. Breast-conserving surgery is widely acknowledged as an effective treatment for breast cancer, and the latissimus dorsi muscle flap is a straightforward, dependable technique for partial breast reconstruction.

Methods

A pedicled segmental latissimus dorsi muscle flap was employed in 20 patients with laterally situated breast cancer treated at our institution from January 2018 to December 2021. During a 6-month postoperative follow-up period, patients were polled on their overall satisfaction and cosmetic satisfaction. Plastic surgeons assessed the aesthetic and functional outcomes in terms of breast shape and symmetry, as well as muscular function.

Results

The mean operative time was 120 ± 35.2 min while the mean postoperative hospital stay was 2.5 days (range, 1.5–3 days). There were no donor site complications such as intraoperative bleeding, postoperative hematoma, or infection, and postoperative drain removal was done on average after 5 days. The average weight of specimens was 50–160 gm with a mean of 100 gm, and the locations of the masses were the upper lateral quadrant (n = 15), the lower lateral quadrant (n = 2), and the central lateral area (n = 3). Complications developed in 6 of the cases, hematoma in 2 cases, wound seroma developed in the donor site in 2 cases, and weakness in shoulder movement in 2 cases, and the majority of the patients were satisfied with their cosmetic outcomes. No tumor recurrence was reported.

Conclusion

Replacement of 20 to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap as nerve-sparing pedicled segmental flap that can be harvested from the same axillary incision of lymphadenectomy is a good alternative reconstruction technique after partial mastectomy. This resulted in an acceptable postoperative scar, less pain, and early upper extremity movement, so this technique is considered a useful and reliable technique in correcting breast deformity after breast-conserving surgery, especially in laterally located breast cancer.

Level of evidence: Level IV, therapeutic study.