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Michel Saintcyr - One of the best experts on this subject based on the ideXlab platform.
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the low transverse extended Latissimus Dorsi Flap based on fat compartments of the back for breast reconstruction anatomical study and clinical results
Plastic and Reconstructive Surgery, 2011Co-Authors: Michel Saintcyr, Corrine Wong, Steven H Bailey, Georgette Oni, Munique MaiaAbstract:Background:Despite many modifications to the extended Latissimus Dorsi Flap, its use in autologous breast reconstruction remains limited because of insufficient volume and donor-site morbidity. Through a detailed analysis of the deposition of back fat, this study describes a low transverse extended
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the pedicled descending branch muscle sparing Latissimus Dorsi Flap for trunk and upper extremity reconstruction
Journal of Plastic Reconstructive and Aesthetic Surgery, 2010Co-Authors: Corrine Wong, Michel SaintcyrAbstract:Summary Background The major blood supply of the Latissimus Dorsi muscle Flap is based on the descending and tranverse branches of the thoracodorsal artery. This segmental blood supply allows the muscle to be split and harvested based solely on vascularization from the descending branch, thus sparing the Latissimus Dorsi muscle function. This article reports the use of the descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap in reconstructing defects on the trunk and upper extremities. Methods Five patients with defects on the trunk or upper extremities had soft tissue reconstruction with a pedicled descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap. A transverse skin paddle design was used in all cases. All Flaps were performed by the senior author. Complications were recorded, and range of motion analysis was performed comparing operated and non-operated sides during follow-up appointments. Results The descending branch muscle-sparing Latissimus Dorsi Flap was used for reconstruction of: the chest wall (2), axilla (2) and upper extremity (1). The skin paddles harvested ranged from 15×7cm to 24×9cm. All donor sites were closed primarily. There was one case of minor wound dehiscence on the donor site and one case of wound infection (reconstruction was for chronic, severe axillary hidradenitis suppuritiva). There were no incidences of seroma. In all cases, there was no difference in strength or range of motion around the shoulder joint when comparing the operated to the non-operated side. Conclusion The pedicled descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, low rate of Flap complications and an aesthetically acceptable scar.
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the pedicled descending branch muscle sparing Latissimus Dorsi Flap for breast reconstruction
Plastic and Reconstructive Surgery, 2009Co-Authors: Michel Saintcyr, Purushottam Nagarkar, Mark Victor Schaverien, Phillip B Dauwe, Corrine Wong, Rod J RohrichAbstract: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 anatomic
Corrine Wong - One of the best experts on this subject based on the ideXlab platform.
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the low transverse extended Latissimus Dorsi Flap based on fat compartments of the back for breast reconstruction anatomical study and clinical results
Plastic and Reconstructive Surgery, 2011Co-Authors: Michel Saintcyr, Corrine Wong, Steven H Bailey, Georgette Oni, Munique MaiaAbstract:Background:Despite many modifications to the extended Latissimus Dorsi Flap, its use in autologous breast reconstruction remains limited because of insufficient volume and donor-site morbidity. Through a detailed analysis of the deposition of back fat, this study describes a low transverse extended
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the pedicled descending branch muscle sparing Latissimus Dorsi Flap for trunk and upper extremity reconstruction
Journal of Plastic Reconstructive and Aesthetic Surgery, 2010Co-Authors: Corrine Wong, Michel SaintcyrAbstract:Summary Background The major blood supply of the Latissimus Dorsi muscle Flap is based on the descending and tranverse branches of the thoracodorsal artery. This segmental blood supply allows the muscle to be split and harvested based solely on vascularization from the descending branch, thus sparing the Latissimus Dorsi muscle function. This article reports the use of the descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap in reconstructing defects on the trunk and upper extremities. Methods Five patients with defects on the trunk or upper extremities had soft tissue reconstruction with a pedicled descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap. A transverse skin paddle design was used in all cases. All Flaps were performed by the senior author. Complications were recorded, and range of motion analysis was performed comparing operated and non-operated sides during follow-up appointments. Results The descending branch muscle-sparing Latissimus Dorsi Flap was used for reconstruction of: the chest wall (2), axilla (2) and upper extremity (1). The skin paddles harvested ranged from 15×7cm to 24×9cm. All donor sites were closed primarily. There was one case of minor wound dehiscence on the donor site and one case of wound infection (reconstruction was for chronic, severe axillary hidradenitis suppuritiva). There were no incidences of seroma. In all cases, there was no difference in strength or range of motion around the shoulder joint when comparing the operated to the non-operated side. Conclusion The pedicled descending branch muscle-sparing Latissimus Dorsi myocutaneous Flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, low rate of Flap complications and an aesthetically acceptable scar.
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the pedicled descending branch muscle sparing Latissimus Dorsi Flap for breast reconstruction
Plastic and Reconstructive Surgery, 2009Co-Authors: Michel Saintcyr, Purushottam Nagarkar, Mark Victor Schaverien, Phillip B Dauwe, Corrine Wong, Rod J RohrichAbstract: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 anatomic
Rod J Rohrich - One of the best experts on this subject based on the ideXlab platform.
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the pedicled descending branch muscle sparing Latissimus Dorsi Flap for breast reconstruction
Plastic and Reconstructive Surgery, 2009Co-Authors: Michel Saintcyr, Purushottam Nagarkar, Mark Victor Schaverien, Phillip B Dauwe, Corrine Wong, Rod J RohrichAbstract: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 anatomic
Marco Innocenti - One of the best experts on this subject based on the ideXlab platform.
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Latissimus Dorsi rotational Flap combined with a custom-made scapular prosthesis after oncological surgical resection: a report of two patients
BMC Cancer, 2018Co-Authors: Giovanni Beltrami, Gabriele Ristori, Guido Scoccianti, Angela Tamburini, Rodolfo Capanna, Domenico Campanacci, Marco InnocentiAbstract:Background Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional Latissimus Dorsi Flap. Case presentation Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a Latissimus Dorsi rotational Flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular Flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed. Conclusions This new technique upgrades the role of the Latissimus Dorsi Flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.
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Latissimus Dorsi rotational Flap combined with a custom made scapular prosthesis after oncological surgical resection a report of two patients
BMC Cancer, 2018Co-Authors: Giovanni Beltrami, Gabriele Ristori, Guido Scoccianti, Angela Tamburini, Rodolfo Capanna, Domenico Campanacci, Marco InnocentiAbstract:Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional Latissimus Dorsi Flap. Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a Latissimus Dorsi rotational Flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular Flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed. This new technique upgrades the role of the Latissimus Dorsi Flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.
Kap Sung Oh - One of the best experts on this subject based on the ideXlab platform.
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extra abdominal desmoid tumor in the donor site of an extended Latissimus Dorsi Flap
Archives of Plastic Surgery, 2016Co-Authors: Jai Kyong Pyon, Bo Young Kang, Sa Ik Bang, Kap Sung OhAbstract:Desmoid tumors are slow-growing fibrous neoplasms, arising from deep musculoaponeurotic structures, and can occur in the abdominal wall, abdominal cavity, or outside the abdomen. Although desmoid tumors are histologically benign and do not metastasize, they are often regarded as semimalignant lesions due to their tendency towards local invasion and repetitive recurrence. Reports suggest that desmoid tumors represent about 0.03% of tumors and less than 3% of all soft tissue tumors. The incidence of desmoid tumors is known to be about two to four persons per million members of the general population per year [1]. Although desmoid tumors are usually associated with Gardner's syndrome, which is a variant of familial adenomatous polyposis, they can arise sporadically. The exact etiology of the development of sporadic desmoid tumors is unknown; however, there have been reports of desmoid tumor development following trauma or abdominal surgery, such as appendectomy, laparotomy, laparoscopic surgery, and cesarean section. In most cases, the tumor occurred within 2 years of the operation, but these tumors can appear at any time, even more than 20 years later. A 51-year-old woman who was previously healthy underwent breast reconstruction with an extended Latissimus Dorsi Flap immediately following a total mastectomy for left breast cancer (Fig. 1). After discharge, she required frequent visits to the outpatient clinic for repeated tapping of refractory seroma and for wound revision because of dehiscence of the back donor site. Fig. 1 Back view of a patient who underwent breast reconstruction with an extended Latissimus Dorsi Flap. Patient complained of a palpable mass with stabbing pain in her donor site. Two years postoperatively, the patient started to complain of a palpable mass with stabbing pain in her donor site just under the linear scar. We removed the capsule under the donor site scar and collected the fluid inside the capsule. The histology revealed chronic inflammation with dense fibrosis. Unfortunately, the excision site needed an additional surgical procedure due to wound infection. As there had been no improvement in the pain with the first excision of the mass, 8 months after the last operation date, we decided to explore the donor site. We found a white mass measuring 4 cm×5 cm in the subcutaneous layer under the incision site. The tumor was composed of a fibrotic component and associated with a small fluid collection in the patient's back (Fig. 2). After removal of the mass, we found no remnant mass on gross examination. Hematoxylin and eosin staining revealed an extra-abdominal desmoid tumor. Immunohistochemical nuclear staining with beta-catenin was positive; this finding is seen in about 85% of sporadic desmoids following mutation of the CTNNB1 gene encoding beta-catenin (Fig. 3). Fig. 2 A white mass measuring 4 cm×5 cm and composed of a fibrotic component. Fig. 3 Immunohistochemistry shows nuclear beta-catenin at 400× magnification. After the operation, the patient had partial return of the pain. Follow-up magnetic resonance image at 12 months post-surgery revealed no sign of recurrence (Fig. 4). Fig. 4 Axial magnetic resonance imaging (T2-weighted image) at 12 months post-surgery. There is no sign of recurrence. The course of development of desmoid tumors is unpredictable, and symptoms vary from patient to patient. Some patients suffer from aggressive progression and recurrence, whereas others exhibit no symptoms. A wide excision with clear margins has long been accepted as the first-line treatment modality. Although a free resection margin is associated with a low rate of recurrence, there remains controversy about the amount of tissue that needs to be resected. Furthermore, the complications of wide tumor resection sometimes outweigh the advantages, as it may result in permanent functional sequelae. Nakayama et al. [2] reviewed clinical outcomes and changes in tumor size in 11 consecutive patients with extremity and trunk desmoid tumors, and suggested that simple observation is a non-invasive and function-preserving treatment. Radiation therapy has been shown to be an effective method to control primary or recurrent lesions in some reports. Cytotoxic chemotherapy has been used in progressive, recurrent, or unresectable tumors. However, the benefit of radiation therapy and chemotherapy remains controversial, due to the risk of complications and the fact that only a small number of patients have been treated by either method so far. The effects of various types of therapy, involving anti-estrogen or non-steroidal anti-inflammatory drugs have also been reported [3]. Treatment strategies can vary from observation to surgery and adjuvant therapy. Given the potential morbidity associated with some of the strategies, the decision should be tailored to the individual and discussed with the patient. Kovacs et al. [4] reported a case of desmoid tumors arising at the Latissimus Dorsi Flap donor site. The patients underwent abdominal resection and reconstruction with a Latissimus Dorsi free Flap for intra-abdominal desmoid tumors. However, the patients had Gardner's syndrome, which is known to be a risk factor of desmoid tumors. They consider this to have been triggered by operative trauma; however, the possibility of iatrogenic metastasis from the abdomen could not be excluded. Paradol et al. [5] also reported a desmoid tumor occurring in a scar at the donor site of a Latissimus Dorsi Flap for breast reconstruction following total mastectomy. In this case, the patient had no history of fibromatosis or polyposis such as Gardner's syndrome. One month after the excisional biopsy revealed the desmoid tumor, wide excision with a 5-cm safety margin, and reconstruction with a local advancement Flap were performed to prevent recurrence [5]. In our case, we could not confirm the presence of a negative margin during the operation. However, because there was no evidence of recurrence during the 1-year follow-up period, we decided to adopt a wait-and-watch approach with regular follow-up examinations every 6 months rather than performing prophylactic wide excision, which might lead to cosmetic dissatisfaction or functional sequelae. It is not easy to diagnose a desmoid tumor because this type of tumor may arise in any location in the body and resemble a capsule or scar tissue in a post-operative site. Therefore, we recommend that clinicians perform a biopsy for early detection in cases where desmoid tumors are suspected, and consider an individualized approach when discussing treatment modalities.
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comparison of morbidity of donor site following pedicled muscle sparing Latissimus Dorsi Flap versus extended Latissimus Dorsi Flap breast reconstruction
Journal of Plastic Reconstructive and Aesthetic Surgery, 2013Co-Authors: Elrica Sapphira Wiraatmadja, Jai Kyong Pyon, Sa Ik Bang, Kap Sung OhAbstract:Summary The pedicled, descending-branch muscle-sparing Latissimus Dorsi (MSLD) Flap has been widely used for breast reconstruction following total mastectomy. However, the superiority of the MSLD Flap compared to the extended Latissimus Dorsi (ELD) Flap has not yet been described. This study compares morbidities following pedicled MSLD Flap and ELD Flap breast reconstruction. A total of 36 women with pedicled MSLD Flaps were compared with 37 women with ELD Flap breast reconstruction. The medical records were reviewed for complications and demographic data. The authors compared morbidity including donor-site seroma, limitation of shoulder movement and aesthetic contour of the donor site following MSLD Flap and ELD Flap breast reconstruction. The authors compared the identified parameters and set the level of significance at the 0.05 alpha level. The demographic data of the two groups were not significantly different statistically. Donor-site seroma occurred in two MSLD patients (5.6%) and in 23 ELD patients (62.2%) ( p = 0.0001). Limitation of shoulder movement occurred in nine MSLD patients (25%) and in 28 ELD patients (75.7%) ( p = 0.0001). Back asymmetry occurred less frequently in the MSLD group ( p = 0.0297). The pedicled, descending-branch MSLD Flap, with its low complication rate and associated with minimal functional and aesthetic deficits of the donor site, can be a good option for breast reconstruction. Level of evidence Therapeutic, III.