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Sample records for latissimus dorsi musculocutaneous

  1. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap.

    PubMed

    Szychta, Pawel; Butterworth, Mark; Dixon, Mike; Kulkarni, Dhananjay; Stewart, Ken; Raine, Cameron

    2013-10-01

    To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction. Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months. The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001). We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. New options in breast reconstructive surgery: alternatives to the latissimus dorsi musculocutaneous flap.

    PubMed

    Berrino, P; Galli, A; Santi, P L

    1986-01-01

    Transposition of the latissimus dorsi musculocutaneous flap is still considered by most authors a first-choice technique for breast reconstruction. However, the aesthetic drawbacks of the technique are significant: In our experience the posterior scar and the "patchlike" skin island are of concern to more than 30% of patients. Recent alternatives have sharply reduced the use of the latissimus dorsi myocutaneous flap as our first-choice technique. The utilization of a latissimus dorsi muscular flap in association with submuscular placement of a tissue expander is now our favorite technique for the majority of patients: Residual scarring is insignificant since the whole muscle can be raised through a 5-7-cm-long, S-shaped incision placed along the anterior border of the latissimus dorsi. The results obtained in a group of 35 patients demonstrate that the final results of the procedure in terms of shape and projection of the reconstructed breasts are absolutely similar to those obtained using the latissimus dorsi musculocutaneous flap. However, in patients with heavy body structure and large contralateral breast, satisfactory symmetry and a natural-looking reconstructed breast are obtained more effectively by transposition of a rectus abdominis myocutaneous flap. The precautions to be taken in order to make the procedure suitable for over-weight patients are described and the results are discussed.

  3. Omentum and reverse turnover latissimus dorsi musculocutaneous flap for the treatment of cerebrospinal fluid fistula.

    PubMed

    Söyüncü, Yetkin; Bigat, Zekiye; Söyüncü, İlkay; Özkan, Ömer

    2015-01-01

    Conventional procedures can usually prevent cerebrospinal fluid (CSF) leakages, but they may not work for complicated cases. In this case presentation, we demonstrated the effectiveness of combined omental and latissimus dorsi musculocutaneous flaps for management of difficult CSF fistula. A reverse turnover latissimus dorsi musculocutaneous flap and omental flap were transferred for reconstruction of the posterior wound and CSF leakage. The omental flap component was used for CSF absorption, and the latissimus dorsi muscle component was used for obliteration of the dead space, covering of the exposed bone, and tension-free closure of the wound. The wound healed dramatically, with no observed severe donor site morbidity. The patient has been followed for 30 months with no evidence of CSF leakage and no pseudomeningocele formation, which was confirmed by magnetic resonance imaging (MRI). Although this is a case presentation, we can say that the combination of the omental and musculocutaneous flaps allow effective treatment and prevention of CSF fistulas in selected high-risk patients and provide durable coverage of complex spinal wounds.

  4. Experimental definition of latissimus dorsi, gracilis, and rectus abdominus musculocutaneous flaps in the dog.

    PubMed

    Gregory, C R; Gourley, I M; Koblik, P D; Patz, J D

    1988-06-01

    Dissection and injection studies in canine cadavers and in anesthetized dogs were conducted to determine the feasibility of using the latissimus dorsi, gracilis, and rectus abdominus muscles as musculocutaneous free flaps. Lengths of vascular pedicles for the latissimus dorsi (2 +/- 0.8 cm), gracilis (1.8 +/- 0.8 cm), and rectus abdominus (1.9 +/- 0.9-cm cranial deep epigastric, 1.7 +/- 0.5-cm caudal deep epigastric), as well as arterial diameters (1.28 +/- 0.31-mm thoracodorsal for the latissimus dorsi, 1.10 +/- 0.33-mm muscular branch for the gracilis, 1.25 +/- 0.25-mm cranial deep epigastric and 1.26 +/- 0.32-mm caudal deep epigastric for the rectus abdominus) were considered satisfactory for microvascular transfer. Fluorometry demonstrated overlying cutaneous perfusion in all flaps based on their muscle vascular pedicles, with the exception of the rectus abdominus flap based on the caudal deep epigastric artery. In this instance, up to 20% of the cutaneous element had questionable or no perfusion.

  5. [Breast reconstruction by musculocutaneous latissimus dorsi flap with single scar and transverse paddle].

    PubMed

    Luini, J; Chaouat, M; Uzzan, C; Boccara, D; Mimoun, M

    2013-02-01

    One of the most frequently used flap in breast reconstruction after mastectomy is the latissimus dorsi musculocutaneous flap. We present a novel method of sampling by extending the mastectomy scar back until the skin paddle. On the one hand, this technique facilitates the transfer of the flap in thoracic region, on the other hand, it allows for larger skin paddle and maximize new breast contour reintegrating the ear skin during the modeling. The data of 37 patients operated by this technique between 2006 and 2009 were reviewed retrospectively. Cosmetic results were analyzed from photographs by a plastic surgeon who was not the operator. The results were highly satisfactory in 45% cases, satisfactory in 40% of cases, fair in 12% of cases and inadequate in 3% of cases. The main advantage of this technique is to collect large skin paddle with a larger width at the ends through increasing opportunities for modeling. Copyright © 2012. Published by Elsevier SAS.

  6. Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.

    PubMed

    Parmaksizoglu, F; Beyzadeoglu, T

    2003-01-01

    Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.

  7. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps.

    PubMed

    Guerra, Aldo Benjamin; Gill, Paul Singh; Trahan, Chris G; Ruiz, Bernardo; Lund, Kerstin M; Delaune, Christie L; Thibodeaux, Brett A; Metzinger, Stephen Eric

    2005-02-01

    Muscle and musculocutaneous flaps have been used reliably in reconstruction of soft-tissue defects for many years. Previous experimental studies have shown musculocutaneous flaps to be superior to the random pattern and fasciocutaneous flaps in the management of infected wounds. Over the past decade, perforator flaps have gained acceptance as alternative methods of reconstruction in the clinical setting that can decrease donor-site morbidity and hospital stay, and increase patient satisfaction. The authors theorized that perforator flaps may be able to handle infected wounds better than random pattern and fasciocutaneous flaps because their blood supply is essentially the same as many of their musculocutaneous counterparts. The goal of this study was to compare the S1 perforator-based skin flap and latissimus dorsi musculocutaneous flap in the dorsal flank of the rabbit with the introduction of bacteria to simulate both superficial and deep wound infection. Measurements of oxygen tension and regional perfusion index were performed on both types of flaps to ascertain their viability and capacity to heal. The authors found no statistical significance between latissimus dorsi musculocutaneous and S1 perforator flaps in the rabbit with respect to superficial and deep wound infections. The regional perfusion index was calculated for postoperative days 1, 2, and 4. No statistically significant difference between the two flaps using the regional perfusion index could be identified. Additionally, regional perfusion for both types of flaps was greater than 0.6, indicating that their capacity to heal wounds is similar.

  8. [Repair of large and deep skin and soft tissue defects around the knee joints with free latissimus dorsi musculocutaneous flaps].

    PubMed

    Zhang, Minghua; Cui, Xu; Zeng, Jizhang; Liu, Xiong; Huang, Mitao; Zhang, Pihong; Huang, Xiaoyuan

    2015-10-01

    To investigate the clinical efficacy of free latissimus dorsi musculocutaneous flaps in repairing large and deep skin and soft tissue defects around the knee joints. Twenty-five patients with large and deep skin and soft tissue defects around the knee joints were hospitalized from March 2005 to March 2014. The area of defects around the knee joints ranged from 10 cm × 8 cm to 43 cm × 23 cm. The free latissimus dorsi musculocutaneous flaps were used to repair the defects, with the area ranging from 12 cm × 10 cm to 45 cm × 25 cm. The thoracodorsal artery and its concomitant vein of the musculocutaneous flap were anastomosed to the descending branch of the lateral circumflex femoral artery and its concomitant vein respectively to reconstruct blood supply. Split-thickness skin grafts around the flap donor sites were harvested to cover the muscle surface of the musculocutaneous flaps. The flap donor sites were closed directly with suture, and the skin donor sites were healed by dressing change. All the 25 flaps survived without vascular crisis. The flaps were in satisfactory appearance. The flap donor sites were healed with linear scar. All the patients were followed up for 3 to 6 months. At last, they were able to stand up and walk. The free latissimus dorsi musculocutaneous flap transplantation is an effective treatment for the repair of large and deep soft tissue defects around the knee joints, and the descending branch of lateral circumflex femoral artery and its concomitant vein are the appropriate recipient vessels.

  9. Modified Free Latissimus Dorsi Musculocutaneous Flap in the Reconstruction of Extensive Postoncologic Defects in the Head and Neck Region

    PubMed Central

    Zhu, Guiquan; Li, Chunhua; Chen, Jin; Cai, Yongcong; Li, Ling; Wang, Zhaohui

    2015-01-01

    Abstract Oncological resection of advanced carcinoma in the head and neck region results in vast defects. The free latissimus dorsi musculocutaneous flap (FLDMF) is one of the most commonly used flaps for the repair of complex head and neck defects. We tried to modify FLDMF to multiple segments or combine it with acellular dermis to fit through-and-through defects in the oral-facial region during the last decade. A retrospective review of patients with FLDMF reconstruction between 2004 and 2012 was undertaken. Demographics, histology, surgical management, disease control and overall survival, complications, radiotherapy, aesthetic outcome, as well as economic results were analyzed. The majority of the patients (66.7%) had recurrent tumors, and the rest of the patients had primary tumor with stage IV. Fourteen patients (38.9%) had a history of prior radiation therapy, whereas 27.8% of the patients had postoperative radiation therapy. The areas of the defects vary from 52 cm2 to 180 cm2 (mean, 86.4 cm2). The flap failed in 1 of the 37 patients. The complications at the recipient site include hematoma (n = 6, 16.7%), venous insufficiency (n = 4, 11.1%), infection (n = 3, 8.3), and partial flap necrosis (n = 2, 5.5%). The donor-site complications include delayed healing, necrosis of skin graft, and limited shoulder function. The 5-year overall survival rate was 39.1%, and the 5-year disease-free survival rate was 22.1%. In conclusion, the FLDMF could be modified to fit vast defects where voluminous tissue is needed to be transferred in the head and neck region. PMID:25723665

  10. Reconstruction of severely infected gluteal osteoradionecrosis using negative-pressure wound therapy and latissimus dorsi musculocutaneous flaps.

    PubMed

    Kim, Sang Wha; Youn, Dong Geun; Hwang, Kyu Tae; Kim, Jeong Tae; Kim, Youn Hwan

    2016-01-01

    Radiotherapy is mandatory for aggressive cancer treatment. Unfortunately, the high-energy radiation used can lead to severe osteoradionecrosis. Radical debridement of devitalized bone and soft tissue coupled with reconstruction using well-vascularized tissues is the accepted treatment for this condition. However, osteoradionecrosis cannot be controlled easily or rapidly. The aim of this study was to present the results of the use of serial negative-pressure wound therapy (NPWT) in combination with a latissimus dorsi myocutaneous flap for treatment of gluteal osteoradionecrosis in a consecutive series of patients. Between January 2003 and December 2012, nine patients underwent reconstruction using serial NPWT and latissimus dorsi myocutaneous flaps. We applied negative-pressure dressings for at least 8 weeks. Final reconstruction was performed after the infection was controlled. The superior gluteal artery and vein were used as recipient vessels in all the cases. The mean interval between operation and radiation therapy was 28.3 ± 8.3 years, and the mean number of debridement performed was 6.3 ± 1. NPWT dressings were applied for 8-12 weeks (mean, 9.3 ± 2 weeks). The defects ranged in size from 14 × 8 cm to 18 × 15 cm. The flap size ranged from 15 × 10 cm to 18 × 15 cm. All flaps survived uneventfully except in one patient who experienced chronic seroma and wound dehiscence. There were no recurrences of osteomyelitis during the follow-up periods (mean, 14 ± 6.1 months). Based on the results obtained from this consecutive series of patients, we suggest that this methodology may provide an alternative approach for the treatment of severe osteoradionecrosis of the gluteal region. © 2015 Wiley Periodicals, Inc.

  11. Early Management, With a Minimal Initial Hospitalization Length, of Major Self-inflicted Rifle Wounds to the Face by a Single Latissimus Dorsi Free Musculocutaneous Flap: A 10-Year Experience

    PubMed Central

    Danino, A. M.; Hariss, P. G.; Servant, J. M.

    2009-01-01

    Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial subunits. These injuries have an extremely high economic impact for the Medicare system. The surgical goal with these patients is to restore basic functions of the face with a rapid morphological improvement. Our hypothesis is as follows: Early restoration of facial segments with a single free multiple island latissimus dorsi flap without primary bone reconstruction can significantly reduce hospitalization time and allow earlier psychiatric therapy with good morphological results. Surgical method: (1) Large debridement, bony stabilization with external fixation, and tracheotomy. (2) Definitive early reconstruction of soft tissue with composite free latissimus dorsi-scapular musculocutaneous flap. (3) Several refinements will optimize the results. Study design: Retrospective case series of lower- and middle-face composite facial close-range high-energy gunshot wound patients were evaluated. Age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, functional outcomes, time of tracheotomy closure, hospitalization duration, and beginning of psychiatric treatment were analyzed. Results: Twelve defects were gunshot wounds, 12 free latissimus dorsi flaps, and no flap losses. Patients received psychiatric treatment after 22 days (7–29); the tracheotomy was removed in 10 patients with normal alimentation in all cases. Mean hospitalization duration was 21 days. Conclusions: Free tissue transfer techniques allow early reconstruction of the soft tissue framework of the face with a single multiple-island flap. Rapid restitution of facial compartments at a soft tissue level can dramatically reduce duration of hospitalization. PMID:19587777

  12. Pedicled Latissimus Dorsi Muscle Flap

    PubMed Central

    Abolhoda, Amir; Bui, Trung D.; Milliken, Jeffrey C.; Wirth, Garrett A.

    2009-01-01

    Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy was performed because of necrotizing, localized Mycobacterium avium-intracellulare infection. One patient underwent right upper lobectomy and main-stem bronchoplasty for carcinoma after chemoradiation therapy. In 3 patients, the pedicled latissimus dorsi muscle was used to obliterate chronic empyema cavities and to buttress the closure of underlying bronchopleural fistulas. No operative deaths or recurrent empyemas resulted. Two patients retained peri-flap air that required no surgical intervention. We conclude that the use of transposed pedicled latissimus dorsi muscle flap effectively and reliably prevents clinically overt bronchopleural fistula and recurrent empyema. We advocate its routine use in first-time and selected reoperative thoracotomies in patients who are undergoing high-risk lung resection or reparative procedures. PMID:19693302

  13. Primary one-stage reconstruction of cheek defect after a shotgun blast to the face: use of the latissimus dorsi musculocutaneous free flap for soft-tissue repair and facial reanimation.

    PubMed

    Safak, T; Akyürek, M

    2001-10-01

    The authors describe a case of a shotgun blast injury to the face in which early definitive repair of both facial soft tissues and facial reanimation was accomplished in one stage using a free flap. The trauma occurred 2 days before presentation via a hunting rifle fired at a short range. On examination, a 8 x 5-cm cheek defect was evident, involving the full thickness of the perioral facial mimetic muscles as well. A free latissimus dorsi musculocutaneous flap was transferred to the defect, with the thoracodorsal nerve coapted to an ipsilateral, severed buccal branch of the facial nerve. Postoperatively, the flap survived completely, with its skin paddle excised subsequently in two stages. Good muscle movement was obtained, providing resting symmetry and a pleasant smile. Other than soft-tissue and bony defects resulting from shotgun injuries, ablation of the facial nerve or facial mimetic muscles may be an important component of the defect that needs further consideration. The authors conclude that the current technique of one-stage, early definitive repair of soft tissues and facial reanimation in such cases of facial shotgun blast injury offers the advantages of achieving both goals with one flap and accomplishing the procedure primarily in one stage.

  14. The morphology and biomechanics of latissimus dorsi.

    PubMed

    Bogduk, Nikolai; Johnson, Garth; Spalding, Deborah

    1998-09-01

    OBJECTIVE: To determine the morphology of the latissimus dorsi in order to assess its actions on the shoulder, the lumbar spine and the sacroiliac joint. DESIGN: A dissection study accompanied by an analysis of the force vectors of the muscle and its parts. BACKGROUND: Although recognised as a muscle of the shoulder, latissimus dorsi has been accorded a role as an extensor of the lumbar spine, and is said to brace the sacroiliac joint. Consideration of the anatomy of the latissimus dorsi suggests that the magnitude of these actions has been overstated. METHODS: The fascicular anatomy of the latissimus dorsi was determined by dissection in five adult cadavers. The size, attachments, and orientation of each fascicle were determined. By applying a force coefficient the maximum force of each fascicle was estimated from its physiological cross-sectional area. By summing the forces and moments of each fascicle the maximum force exerted by latissimus dorsi was calculated for its actions on the shoulder, the lumbar spine, and the sacroiliac joint. RESULTS: The latissimus dorsi was found to consist of a series of fascicles with segmental attachments to the lower six thoracic spinous processes, the L1 and L2 spinous processes, the lateral raphe of the thoracolumbar fascia, the iliac crest and the lower three ribs. These fascicles were uniform in size across a given muscle but varied from specimen to specimen. The maximum total force exerted by the latissimus dorsi on the shoulder was estimated to range between 162 and 529 N, but in view of the attachments of the muscle, only a portion of that force can be exerted on the lumbar spine. The maximum extensor moment exerted on the lumbar spine was calculated to be 6.3 N m. The maximum force exerted across the sacroiliac joint was calculated to be 30 N. CONCLUSIONS: The latissimus dorsi is designed to move the upper limb or to raise the entire trunk in brachiation. Its possible contribution to extension of the lumbar spine is

  15. Salvage of extensively burned upper limbs by a pedicled latissimus dorsi flap.

    PubMed

    Delay, E; Foyatier, J L; el Kollali, R; Comparin, J P; Weil, E; Latarjet, J

    1995-09-01

    Very deep burns of the arm and elbow lead to soft tissue necrosis and infection with exposure of important structures. Aggressive debridement should be performed as early as possible to cut the vicious circle, and the defect, which may be extensive, should be covered by well-vascularized tissues. The reliability and versatility of the pedicled latissimus dorsi muscle or musculocutaneous flap make it our first choice in the management of this problem. A retrospective study of three patients for whom salvage of the upper limb has been achieved by the use of a pedicled latissimus dorsi flap is presented, illustrating the advantages of this technique.

  16. Primary Fat Grafting to the Pectoralis Muscle during Latissimus Dorsi Breast Reconstruction

    PubMed Central

    Vidal, Luciano; Hersant, Barbara; Meningaud, Jean Paul

    2016-01-01

    Background: Latissimus dorsi flap is one of the best options for immediate and delayed breast reconstruction. However, this technique is limited by the tissue volume provided by the flap. To improve breast volume while reducing complications, fat grafting is now very often used in addition to latissimus dorsi flap. To the best of our knowledge, fat grafting was always performed as a second-line surgery, at least a few months after the flap procedure. We aimed to report our experience with an associated breast reconstruction technique combining musculocutaneous latissimus dorsi flap with intrapectoral lipofilling for totally autologous breast reconstruction. Methods: Between September 2014 and January 2015, 20 patients underwent this technique for unilateral autologous breast reconstruction (14 delayed and 6 immediate breast reconstructions). A mean harvested fat volume of 278 ml (range: 190–350 ml) and a mean injected fat volume of 228 ml (range: 170–280 ml) were used. Results: None of the patients experienced complications, such as flap necrosis, breast skin necrosis, hematomas, or infection. One of the patients developed a seroma, which was treated with 3 drainage punctions. Only 2 patients underwent delayed fat grafting procedure. Conclusion: Totally autologous breast reconstruction combining latissimus dorsi flap and intrapectoral fat grafting in the same procedure is a new technique allowing increased breast volume in a single surgery. PMID:27975006

  17. The bipedicled latissimus dorsi myocutaneous free flap: clinical experience with 53 patients.

    PubMed

    Karaaltin, Mehmet Veli; Erdem, Adnan; Canter, Ibrahim; Cavdar, Günay; Baghaki, Semih

    2010-01-01

    The Latissimus dorsi musculocutaneous flap is a valuable workhorse of the microsurgeon, especially in closing large body defects. One of the pitfalls in harvesting the flap, is particularly in its inferior aspect which may be unreliable. Here we report a series of 53 patients who were undergone bipedicled free latissimus dorsi musculocutaneous free flaps for extensive tissue defects. The age of patients were between 5 and 64 and all of them were males. The wound sizes in these patients ranged between 31-35 x 10-12 cm and flap dimensions were between 38-48 x 6-8 cm. Perforator branches of the 10th intercostal vessels were dissected and supercharged to the flaps to reduce the risk of ischemia of the inferior cutaneous extensions. The secondary pedicles were anastomosed to recipient vessels other than the primary pedicles. Recipient areas were consisted of lower extremities. Four patients suffered of early arterial failure in the major pedicle and all revisions were successfully attempted. Neither sign of venous congestion nor arterial insufficiency were observed at the inferior cutaneous extensions of the flaps, and all defects were reconstructed successfully. All donor sites were primarily closed, only two patients suffered from a minor area of superficial epidermal loss at the donor site, without suffering any adjunct complications. In conclusion coverage of large defects can be safely performed with extending the skin paddle of latissimus dorsi flap as a bipedicled free flap.

  18. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction

    PubMed Central

    Friedman, Michael V.; Stensby, J. Derek; Hillen, Travis J.; Demertzis, Jennifer L.; Keener, Jay D.

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a “muscle up.” Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. PMID:26502450

  19. Autologous breast reconstruction with the extended latissimus dorsi flap.

    PubMed

    Chang, David W; Youssef, Adel; Cha, Sumi; Reece, Gregory P

    2002-09-01

    The extended latissimus dorsi myocutaneous flap can provide autogenous tissue replacement of breast volume without an implant. Nevertheless, experience with the extended latissimus dorsi flap for breast reconstruction is relatively limited. In this study, the authors evaluated their experience with the extended latissimus dorsi flap for breast reconstruction to better understand its indications, limitations, complications, and clinical outcomes. All patients who underwent breast reconstruction with extended latissimus dorsi flaps at the authors' institution between January of 1990 and December of 2000 were reviewed. During the study period, 75 extended latissimus dorsi flap breast reconstructions were performed in 67 patients. Bilateral breast reconstructions were performed in eight patients, and 59 patients underwent unilateral breast reconstruction. There were 45 immediate and 30 delayed reconstructions. Mean patient age was 51.5 years. Mean body mass index was 31.8 kg/m2. Flap complications developed in 21 of 75 flaps (28.0 percent), and donor-site complications developed in 29 of 75 donor sites (38.7 percent). Mastectomy skin flap necrosis (17.3 percent) and donor-site seroma (25.3 percent) were found to be the most common complications. There were no flap losses. Patients aged 65 years or older had higher odds of developing flap complications compared with those 45 years or younger (p = 0.03). Patients with size D reconstructed breasts had significantly higher odds of flap complications compared with those with size A or B reconstructed breasts (p = 0.05). Obesity (body mass index greater than or equal to 30 kg/m2) was associated with a 2.15-fold increase in the odds of developing donor-site complications compared with patients with a body mass index less than 30 kg/m2 (p = 0.01). No other studied factors had a significant relationship with flap or donor-site complications. In most patients, the extended latissimus dorsi flap alone, without an implant, can

  20. Electromyographic activity after latissimus dorsi transfer: testing of coactivation as a simple tool to assess latissimus dorsi motor learning.

    PubMed

    Plath, Johannes E; Seiberl, Wolfgang; Beitzel, Knut; Minzlaff, Philipp; Schwirtz, Ansgar; Imhoff, Andreas B; Buchmann, Stefan

    2014-08-01

    The purpose of this study was to investigate coactivation (CoA) testing as a clinical tool to monitor motor learning after latissimus dorsi tendon transfer. We evaluated 20 patients clinically with the American Shoulder and Elbow Surgeons (ASES) and University of California-Los Angeles (UCLA) outcomes scores, visual analog scale, active external rotation (aER), and isometric strength testing in abduction and external rotation. Measurements of aER were performed while the latissimus dorsi was activated in its new function of external rotation with concomitant activation (coactivation) of its native functions (adduction and extension). Bilateral surface electromyographic (EMG) activity was recorded during aER measurements and the strength testing procedure (EMG activity ratio: with/without CoA). Patients were divided into two groups (excellent/good vs fair/poor) according to the results of the ASES and UCLA scores. The mean follow-up was 57.8 ± 25.2 months. Subdivided by clinical scores, the superior outcome group lost aER with CoA, whereas the inferior outcome group gained aER (UCLA score: -2.2° ± 7.4° vs +4.3° ± 4.1°; P = .031). Patients with inferior outcomes in the ASES score showed higher latissimus dorsi EMG activity ratios (P = .027), suggesting an inadequate motor learning process. Isometric strength testing revealed that the latissimus dorsi transfer had significantly greater activity compared with the contralateral side (external rotation, P = .008; abduction, P = .006) but did not have comparable strength (external rotation, P = .017; abduction, P = .009). Patients with inferior clinical results were more likely to be dependent on CoA to gain external rotation. Therefore, CoA testing may be used as a tool to evaluate the status of postoperative motor learning after latissimus dorsi transfer. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  1. Case Report Reconstruction of Exposed Ilium With Reverse Turnover Latissimus Dorsi Muscle Flap

    PubMed Central

    Hayashida, Kenji; Endo, Yoshie; Kamebuchi, Katsuhiko

    2011-01-01

    Objective: It is difficult to cover a large skin and soft tissue defect with exposure of the ilium. We therefore performed a new reconstruction technique, using a reverse latissimus dorsi muscle flap fed by perforating branches of only the 10th intercostal artery. Methods: A 45-year-old man had a large traumatic defect located on the hip with exposure of the iliac crest. After confirming and preserving perforating branches of the 10th intercostal artery, the latissimus dorsi muscle flap was turned over just proximal to the perforating branch, and a split-thickness skin graft was performed over the flap. Results: The skin graft took place well and there were no circulation problems. Conclusions: This flap covered a larger area on the hip than the musculocutaneous flap. Furthermore, this is easier to perform and is less invasive than a vascularized free flap. Skin and soft tissue defects that expose bones of the lumbar or hip region can be reconstructed with a local flap; however, the deficit is small for this coverage and usually there is little skin and soft tissue to cover the wound defect in the surrounding area. Thus, it is often difficult to deal with large defects. We performed a reconstruction, using a reverse latissimus dorsi flap fed by perforating branches of the 10th intercostal artery for a large skin and soft tissue defect of the hip with exposure of the iliac crest, resulting in a good outcome. This technique is thought to be useful for reconstruction when the ilium is exposed, and we report the case and surgical procedure. PMID:21559059

  2. Coverage of Amputation Stumps Using a Latissimus Dorsi Flap With a Serratus Anterior Muscle Flap: A Comparative Study.

    PubMed

    Kim, Sang Wha; Jeon, Seung Bae; Hwang, Kyu Tae; Kim, Youn Hwan

    2016-01-01

    Amputation of the extremities is a definitive reconstructive option, and surgeons should aim to preserve maximum overall function. If the exposed bone cannot be adequately covered using local tissues, the stump can be reconstructed using a number of well-described free flap transfer techniques. Between January 2002 and December 2011, 31 patients with severe injuries to the lower extremities underwent above-the-knee, below-the-knee, and Chopart and Ray amputations. Bony stumps were covered using latissimus dorsi myocutaneous flaps alone (group 1), or together with serratus anterior muscle flaps (group 2). The groups were compared with respect to age, flap survival, skin flap size, immediate complications, wound sloughing, deep ulceration, need for bone amputation, limb visual analog scale score, time to prosthesis, and follow-up duration. The mean area of the latissimus dorsi skin flap was 255.9 cm, and immediate complications occurred in 8 (25.8%) patients. In the double-padding group, there were fewer cases of deep ulceration than in the single-flap group, and prostheses could be worn sooner. There were no statistically significant differences in other parameters. Successful reconstruction of amputation stumps requires an adequate, durable, weight-bearing, and well-contoured soft tissue cover. A latissimus dorsi musculocutaneous flap together with a serratus anterior muscle flap provides well-vascularized muscle tissue and a durable skin paddle, leading to less ulceration than conventional flap techniques.

  3. Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction: Bad Rap or Good Flap?

    PubMed Central

    Perdikis, Galen; Koonce, Stephanie; Collis, George; Eck, Dustin

    2011-01-01

    Objective: This article serves to review latissimus dorsi myocutaneous flap as an option for breast reconstruction postmastectomy. Since the introduction of the latissimus dorsi myocutaneous flap in the late 1970s, its use has always been as a secondary technique, particularly after the development of the transverse rectus abdominus myocutaneous flap in the 1980s. Methods: A literature review of the history of latissimus dorsi myocutaneous flap utilized for breast reconstruction as well as a review of our institution's experience with latissimus dorsi myocutaneous flap and tissue expander placement was performed. Results: There remains a paucity of published studies investigating latissimus dorsi myocutaneous flap for breast reconstruction. Most studies have small numbers and do not utilize tissue expanders. More recently several small studies have been published that show acceptably low complication rates with aesthetically pleasing outcomes when latissimus dorsi myocutaneous flap is employed with a tissue expander. At our institution, we have employed latissimus dorsi myocutaneous flap with tissue expander placement for both delayed and immediate reconstruction with subsequent replacement with a permanent implant with a capsular contraction rate of 10.5%. Our data and others more recently published demonstrate very acceptable capsular contracture rates and aesthetic outcomes, particularly when an expander is utilized. Conclusion: The latissimus dorsi myocutaneous flap remains an excellent choice for breast reconstruction with a low risk of complications. PMID:22031843

  4. Combined latissimus dorsi and serratus anterior flaps for pelvic reconstruction.

    PubMed

    Phan, Truong Q V; Spilker, Gerald; Theodorou, Panagiotis; Gossmann, Andreas; Heiss, Michael; Weinand, Christian

    2011-10-01

    In recurrent pressure sores, adjacent tissue has already been consumed by multiple surgeries. Additional problems are several co-morbidities of patients. Especially, severe atherosclerosis would be a contraindication for using free flaps. However, microsurgical techniques allow circumventing these limitations and preparing even severely atherosclerotic vessels. We performed a total of eight sacral pressure sore coverage in our standardized fashion, using the free combined latissimus dorsi and serratus anterior free flaps. All patients had severe atherosclerosis and needed large soft tissue coverage of the sacral defects. Five patients presented after bowel resection, three with recurrent sacral pressure sores. The average follow-up was 12 months. Postoperatively, all patients were allowed to be prone on the operated area. One minor wound dehiscence was sutured in local anesthesia. CT imaging analysis of the pelvis showed complete void space coverage. The combined latissimus dorsi and serratus anterior flaps are a valuable tool for pelvic reconstruction in our hands. In addition, severe atherosclerosis should not be considered an obstacle to microsurgery and the use of free flaps.

  5. Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

    PubMed Central

    Anastasopoulos, Panagiotis P.; Alexiadis, George; Spyridonos, Sarantis; Fandridis, Emmanouil

    2017-01-01

    Background: Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. Methods: Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. Results: Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. Conclusion: Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component. PMID:28400877

  6. Latissimus dorsi free flap for coverage of sacral radiodermatitis in the ambulatory patient

    SciTech Connect

    Stark, D.; Tofield, J.J.; Terranova, W.; Hurley, D.; Kenney, J.

    1987-07-01

    Ambulatory patients with large sacral ulcers can represent extremely challenging coverage problems. Technical options become fewer when sacral ulcers are coupled with radiation dermatitis. Latissimus dorsi free flap transfer, with direct anastomoses to sacral vessels, is described in 2 patients.

  7. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap.

    PubMed

    Munhoz, Alexandre Mendonça; Montag, Eduardo; Arruda, Eduardo; Okada, Alberto; Brasil, José Augusto; Gemperli, Rolf; Filassi, José Roberto; Ferreira, Marcus Castro

    2011-06-01

    Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

  8. The relationship between latissimus dorsi stiffness and altered scapular kinematics among asymptomatic collegiate swimmers.

    PubMed

    Laudner, Kevin G; Williams, Jeffrey G

    2013-02-01

    To determine the strength of the relationship between latissimus dorsi stiffness and altered scapular kinematics among swimmers. Cross sectional. Laboratory. Nineteen NCAA Division III swimmers (7 male, 12 female) (age = 18.8 ± 0.9 years, height = 174.7 ± 8.9 cm, mass = 71.6 ± 11.9 kg) volunteered to participate. Subjects had no recent history of upper extremity pathology or any previous surgery. We measured latissimus dorsi stiffness of the dominant arm while in a lengthened position with a myotonometer. We used an electromagnetic tracking device with specialized software to measure scapular kinematics at humeral elevation angles of 30°, 60°, 90°, and 110° within the scapular plane. Latissimus dorsi stiffness and scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt. Latissimus dorsi stiffness showed moderate-to-good relationships with increased scapular upward rotation (r > -0.63, P < 0.002) and posterior tilt (r > -0.62, P < 0.004) at all four angles of humeral elevation. Increased latissimus dorsi stiffness also showed moderate-to-good relationships with decreased scapular internal rotation at humeral elevation angles of 60° (r = 0.47, P = 0.03) and 90° (r = 0.54, P = 0.01). Our results suggest there are several moderate-to-good relationships between increased latissimus dorsi stiffness in swimmers and altered scapular upward rotation, internal rotation, and posterior tilt at various angles of humeral elevation. If latissimus dorsi stiffness is not addressed subsequent scapular alterations, which have been associated with shoulder dysfunction, may occur. Published by Elsevier Ltd.

  9. Activity Patterns in Latissimus Dorsi and Sternocleidomastoid in Classical Singers

    PubMed Central

    Watson, Alan H.D.; Williams, Caitlin; James, Buddug V.

    2012-01-01

    Summary Objectives The aim of this study was to investigate and compare the roles of the accessory respiratory muscles, latissimus dorsi (LD), and sternocleidomastoid, in classical singing. Methods Electromyography was used to record the activity of these muscles in six classically trained female singers carrying out a number of singing and nonsinging tasks. Movements of the chest and abdominal walls were monitored simultaneously using inductive plethysmography, and the sound of the phonations was recorded. Results In normal breathing, LD is active transiently during very deep inhalations and in inhalation against resistance. During exhalation it becomes active again as residual capacity is approached or when air is expelled with great force. Sternocleidomastoid (SCM) supports inhalation when lung volume nears 100% vital capacity or when this is very rapid. All singers engaged LD in supported singing where it was associated with maintaining an expanded thorax. In coloratura singing, pulses of activity of increasing amplitude were often seen in LD toward the end of the breath. These were synchronized with each note. During a short phrase typical of the end of an aria, which was sung at full volume with the projected voice, both LD and SCM were active simultaneously. Spectral analysis of muscle activity demonstrated that in some singers, activity in LD and more rarely SCM, fluctuated in phase with vibrato. Conclusions LD appears to play a significant role in maintaining chest expansion and the dynamic processes underlying vibrato and coloratura singing in classically trained singers. PMID:21724365

  10. Activity patterns in latissimus dorsi and sternocleidomastoid in classical singers.

    PubMed

    Watson, Alan H D; Williams, Caitlin; James, Buddug V

    2012-05-01

    The aim of this study was to investigate and compare the roles of the accessory respiratory muscles, latissimus dorsi (LD), and sternocleidomastoid, in classical singing. Electromyography was used to record the activity of these muscles in six classically trained female singers carrying out a number of singing and nonsinging tasks. Movements of the chest and abdominal walls were monitored simultaneously using inductive plethysmography, and the sound of the phonations was recorded. In normal breathing, LD is active transiently during very deep inhalations and in inhalation against resistance. During exhalation it becomes active again as residual capacity is approached or when air is expelled with great force. Sternocleidomastoid (SCM) supports inhalation when lung volume nears 100% vital capacity or when this is very rapid. All singers engaged LD in supported singing where it was associated with maintaining an expanded thorax. In coloratura singing, pulses of activity of increasing amplitude were often seen in LD toward the end of the breath. These were synchronized with each note. During a short phrase typical of the end of an aria, which was sung at full volume with the projected voice, both LD and SCM were active simultaneously. Spectral analysis of muscle activity demonstrated that in some singers, activity in LD and more rarely SCM, fluctuated in phase with vibrato. LD appears to play a significant role in maintaining chest expansion and the dynamic processes underlying vibrato and coloratura singing in classically trained singers. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  11. Architectural analysis and predicted functional capability of the human latissimus dorsi muscle

    PubMed Central

    Gerling, Michael E; Brown, Stephen H M

    2013-01-01

    The latissimus dorsi is primarily considered a muscle with actions at the shoulder, despite its widespread attachments at the spine. There is some dispute regarding the potential contribution of this muscle to lumbar spine function. The architectural design of a muscle is one of the most accurate predictors of muscle function; however, detailed architectural data on the latissimus dorsi muscle are limited. Therefore, the aim of this study was to quantify the architectural properties of the latissimus dorsi muscle and model mechanical function in light of these new data. One latissimus dorsi muscle was removed from each of 12 human cadavers, separated into regions, and micro-dissected for quantification of fascicle length, sarcomere length, and physiological cross-sectional area. From these data, sarcomere length operating ranges were modelled to determine the force–length characteristics of latissimus dorsi across the spine and shoulder ranges of motion. The physiological cross-sectional area of latissimus dorsi was 5.6 ± 0.5 cm2 and normalized fascicle length was 26.4 ± 1.0 cm, indicating that this muscle is designed to produce a moderate amount of force over a large range of lengths. Measured sarcomere length in the post-mortem neutral spine posture was nearly optimal at 2.69 ± 0.06 μm. Across spine range of motion, biomechanical modelling predicted latissimus dorsi acts across both the ascending and descending limbs of the force–length curve during lateral bend, and primarily at or near the plateau region (where maximum force generation is possible) during flexion/extension and axial twist. Across shoulder range of motion, latissimus dorsi acts primarily on the plateau region and descending limbs of the force length curve during both flexion/extension and abduction/adduction. These data provide novel insights into the ability of the latissimus dorsi muscle to generate force and change length throughout the spine and shoulder ranges of motion. In addition

  12. Architectural analysis and predicted functional capability of the human latissimus dorsi muscle.

    PubMed

    Gerling, Michael E; Brown, Stephen H M

    2013-08-01

    The latissimus dorsi is primarily considered a muscle with actions at the shoulder, despite its widespread attachments at the spine. There is some dispute regarding the potential contribution of this muscle to lumbar spine function. The architectural design of a muscle is one of the most accurate predictors of muscle function; however, detailed architectural data on the latissimus dorsi muscle are limited. Therefore, the aim of this study was to quantify the architectural properties of the latissimus dorsi muscle and model mechanical function in light of these new data. One latissimus dorsi muscle was removed from each of 12 human cadavers, separated into regions, and micro-dissected for quantification of fascicle length, sarcomere length, and physiological cross-sectional area. From these data, sarcomere length operating ranges were modelled to determine the force-length characteristics of latissimus dorsi across the spine and shoulder ranges of motion. The physiological cross-sectional area of latissimus dorsi was 5.6±0.5 cm2 and normalized fascicle length was 26.4±1.0 cm, indicating that this muscle is designed to produce a moderate amount of force over a large range of lengths. Measured sarcomere length in the post-mortem neutral spine posture was nearly optimal at 2.69±0.06 μm. Across spine range of motion, biomechanical modelling predicted latissimus dorsi acts across both the ascending and descending limbs of the force-length curve during lateral bend, and primarily at or near the plateau region (where maximum force generation is possible) during flexion/extension and axial twist. Across shoulder range of motion, latissimus dorsi acts primarily on the plateau region and descending limbs of the force length curve during both flexion/extension and abduction/adduction. These data provide novel insights into the ability of the latissimus dorsi muscle to generate force and change length throughout the spine and shoulder ranges of motion. In addition, these

  13. Complex posterior thoracic wall reconstruction using a crossover combined latissimus dorsi and serratus anterior free flap.

    PubMed

    Bodin, Frédéric; Dissaux, Caroline; Steib, Jean-Paul; Massard, Gilbert

    2016-03-01

    Radical resection of an extended malignant sarcoma of the chest wall requires full-thickness thoracic chest wall reconstruction. Reconstruction is tedious in the case of posteriorly located tumours, because the ipsilateral pedicled myocutaneous latissimus dorsi flap is involved and hence not usable for soft tissue coverage. We report an original case of a left giant dorsal chondrosarcoma originating from the 11th costovertebral joint. After extended resection and skeletal reconstruction, soft tissue coverage was achieved with an original contralateral free flap encompassing both latissimus dorsi and serratus anterior muscles. The flap pedicle was anastomosed to the ipsilateral thoracodorsal vessels.

  14. Acute Traumatic Tear of Latissimus Dorsi Muscle in an Elite Track Athlete

    PubMed Central

    Çelebi, Mehmet Mesut; Ergen, Emin; Üstüner, Evren

    2013-01-01

    Soft tissue injuries constitute 30-50% of all sports related injuries; however, injury to the latissimus dorsi muscle is quite rare with only a few cases reported in the literature. Herein, we describe an acute traumatic tear of the latissimus dorsi muscle in an elite track athlete, which has not been reported in the track and field sports before. The injury was caused by forceful resisted arm adduction that took place at hurdling and starting from the block. A pseudotumor appearance in the axillary region was misdiagnosed as a mass. The diagnosis was made by ultrasound alone and the patient was managed conservatively. PMID:24765503

  15. Acute traumatic tear of latissimus dorsi muscle in an elite track athlete.

    PubMed

    Celebi, Mehmet Mesut; Ergen, Emin; Ustüner, Evren

    2013-08-02

    Soft tissue injuries constitute 30-50% of all sports related injuries; however, injury to the latissimus dorsi muscle is quite rare with only a few cases reported in the literature. Herein, we describe an acute traumatic tear of the latissimus dorsi muscle in an elite track athlete, which has not been reported in the track and field sports before. The injury was caused by forceful resisted arm adduction that took place at hurdling and starting from the block. A pseudotumor appearance in the axillary region was misdiagnosed as a mass. The diagnosis was made by ultrasound alone and the patient was managed conservatively.

  16. [Comparison of the Latissimus dorsi insertions on the iliac crest in chimpanzee (Pan troglodytes) and in man].

    PubMed

    Vacher, C; Ben Hadj Yahia, S; Braun, M; Journeau, P

    2014-03-01

    Comparing to other primates, one of the most important specificities of the human anatomy are consequences of bipedalism. Although bone consequences are well known (lumbar lordosis, horizontal position of the foramen magnum, lengthening of the lower limbs, reduction of the pelvis, specialization of the foot), consequences of our locomotion on the Latissimus dorsi are still unclear. One dissection of a chimpanzee Latissimus dorsi (Pan troglodytes) has been performed and compared to 30 human Latissimus dorsi dissections (10 fresh cadavers and 20 formoled cadavers). In each dissection, the existence of direct muscular insertions on the iliac crest has been investigated and the constitution of the thoracolumbar fascia has been described. In chimpanzee dissection, a muscular direct insertion of the Latissimus dorsi was present on the iliac crest of 9 cm long. The TLF was made of the superficial and the deep fascias of the Latissimus dorsi and the superficial fascia of the erector spinae muscles which was deeper. In man, there was no direct muscular insertion of the Latissimus dorsi in 90 % of cases, the TLF was constituted the same way. This study suggests that the Latissimus dorsi has been separated from the iliac crest in man during the evolution because of the permanent bipedalism and that it stayed inserted on the iliac crest in chimpanzee because of the brachiation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Harvest technique for pedicled transposition of latissimus dorsi muscle: an old trade revisited.

    PubMed

    Abolhoda, Amir; Wirth, Garrett A; Bui, Trung D; Milliken, Jeffrey C

    2008-05-01

    Transposition of extrathoracic muscle flaps has been the cornerstone of treatment of a number of complex intrathoracic pathologies such as bronchopleural fistulas and residual infected pleural spaces. We present a simple step-wise technique for preservation and harvesting of the most common muscle flap employed by thoracic surgeons, namely latissimus dorsi, just prior to performing a standard posterolateral thoracotomy. Since 2004, we have successfully utilized pedicled latissimus muscle as our preferred prophylactic flap against development of postoperative bronchopleural fistulas or recurrent empyemas. This technique should be part of every thoracic surgeon's surgical armamentarium.

  18. Inspiratory muscle fatigue affects latissimus dorsi but not pectoralis major activity during arms only front crawl sprinting.

    PubMed

    Lomax, Mitch; Tasker, Louise; Bostanci, Ozgur

    2014-08-01

    The purpose of this study was to determine whether inspiratory muscle fatigue (IMF) affects the muscle activity of the latissimus dorsi and pectoralis major during maximal arms only front crawl swimming. Eight collegiate swimmers were recruited to perform 2 maximal 20-second arms only front crawl sprints in a swimming flume. Both sprints were performed on the same day, and IMF was induced 30 minutes after the first (control) sprint. Maximal inspiratory and expiratory mouth pressures (PImax and PEmax, respectively) were measured before and after each sprint. The median frequency (MDF) of the electromyographic signal burst was recorded from the latissimus dorsi and pectoralis major during each 20-second sprint along with stroke rate and breathing frequency. Median frequency was assessed in absolute units (Hz) and then referenced to the start of the control sprint for normalization. After IMF inducement, stroke rate increased from 56 ± 4 to 59 ± 5 cycles per minute, and latissimus dorsi MDF fell from 67 ± 11 Hz at the start of the sprint to 61 ± 9 Hz at the end. No change was observed in the MDF of the latissimus dorsi during the control sprint. Conversely, the MDF of the pectoralis major shifted to lower frequencies during both sprints but was unaffected by IMF. As the latter induced fatigue in the latissimus dorsi, which was not otherwise apparent during maximal arms only control sprinting, the presence of IMF affects the activity of the latissimus dorsi during front crawl sprinting.

  19. Reconstruction of a large upper arm defect with muscle sparing latissimus dorsi.

    PubMed

    Cadenelli, Pierfrancesco; Bordoni, Daniele; Ornelli, Matteo; Radaelli, Stefano

    2016-08-23

    Reconstruction of large soft tissue defects in the upper arm represents a challenge for the reconstructive surgeon. The latissimus dorsi flap is widely used and preferred for this latter type of reconstruction due to its reliability and versatility, although sacrificing the entire muscle can lead to higher incidences of postoperative seroma and functional disability. The recent introduction of the perforator-based flap concept has led to an evolution in upper extremity reconstruction by significantly reducing donor-site morbidity and simultaneously ensuring optimal soft tissues coverage. We report a case of a large soft tissue defect of the posterolateral part of the upper arm, consequent to a sarcoma resection, in which a muscle-sparing latissimus dorsi technique was used to obtain total soft tissue coverage. A 2-year follow-up showed a satisfactory functional result and no evidence of recurrence.

  20. Treatment of recalcitrant air leaks: the combined latissimus dorsi-serratus anterior flap.

    PubMed

    Woo, Evan; Tan, Bien-Keem; Lim, Chong-Hee

    2009-08-01

    Pleural space problems after lung resection and persistent air leaks are among the commonest challenges posed to thoracic surgeons. Surgical repair of air leaks are indicated when conventional tube thoracostomy has failed to solve the problem. We would like to propose the novel application of the combined latissimus dorsi-serratus anterior transposition flap for selected cases of air leaks that are recalcitrant to conventional treatment. We discuss its indications and the surgical technique. Five patients underwent the procedure between 2004 and 2007. They were male patients aged between 32 and 70 years. Four patients had alveolar-pleural fistulas resulting in persistent air leaks while the fifth patient had, in addition, a space problem following lung volume reduction surgery. All patients had prolonged treatment with chest drains without success. With the patient in a lateral decubitus position, a lazy-S incision was used to expose the entire latissimus dorsi and the proximal slips of the serratus anterior muscles. They were raised as pedicled flaps and transferred in tandem. The latissimus dorsi was introduced into the pleural cavity via a thoracic window and used to reinforce the fistula repair. The serratus anterior muscle closed the rib window. In all cases, the lungs reexpanded and chest drains were removed within 5 days post surgery. There were no recurrent air leaks at 1-year follow-up with all patients. Conservative treatment in all our patients was unsuccessful. The dual flap technique has the advantage of allowing normal ventilation while providing a seal over the alveolar-pleural fistula. The muscle bulk of the latissimus dorsi fills the pleural dead space and the serratus anterior muscle seals the axilla preventing subcutaneous emphysema. There was minimal morbidity associated with the use of this dual muscle flap technique. This technique is an effective treatment option for recalcitrant air leaks.

  1. Multiple-digit resurfacing using a thin latissimus dorsi perforator flap.

    PubMed

    Kim, Sang Wha; Lee, Ho Jun; Kim, Jeong Tae; Kim, Youn Hwan

    2014-01-01

    Traumatic digit defects of high complexity and with inadequate local tissue represent challenging surgical problems. Recently, perforator flaps have been proposed for reconstructing large defects of the hand because of their thinness and pliability and minimal donor site morbidity. Here, we illustrate the use of thin latissimus dorsi perforator flaps for resurfacing multiple defects of distal digits. We describe the cases of seven patients with large defects, including digits, circumferential defects and multiple-digit defects, who underwent reconstruction with thin latissimus dorsi perforator flaps between January 2008 and March 2012. Single-digit resurfacing procedures were excluded. The mean age was 56.3 years and the mean flap size was 160.4 cm(2). All the flaps survived completely. Two patients had minor complications including partial flap loss and scar contracture. The mean follow-up period was 11.7 months. The ideal flap for digit resurfacing should be thin and amenable to moulding, have a long pedicle for microanastomosis and have minimal donor site morbidity. Thin flaps can be harvested by excluding the deep adipose layer, and their high pliability enables resurfacing without multiple debulking procedures. The latissimus dorsi perforator flap may be the best flap for reconstructing complex defects of the digits, such as large, multiple-digit or circumferential defects, which require complete wrapping of volar and dorsal surfaces.

  2. Isolated latissimus dorsi transfer to restore shoulder external rotation in adults with brachial plexus injury.

    PubMed

    Ghosh, S; Singh, V K; Jeyaseelan, L; Sinisi, M; Fox, M

    2013-05-01

    In adults with brachial plexus injuries, lack of active external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper limb function. There is a paucity of evidence to address this complex issue. We present our experience of isolated latissimus dorsi (LD) muscle transfer to achieve active external rotation. This is a retrospective review of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All patients were male with a mean age of 34 years (21 to 57). All the patients underwent isolated LD muscle transfer using a standard technique to correct external rotational deficit. Outcome was assessed for improvement in active external rotation, arc of movement, muscle strength and return to work. The mean improvement in active external rotation from neutral was 24° (10° to 50°). The mean increase in arc of rotation was 52° (38° to 55°). Mean power of the external rotators was 3.5 Medical Research Council (MRC) grades (2 to 5). A total of 21 patients (88%) were back in work by the time of last follow up. Of these, 13 had returned to their pre-injury occupation. Isolated latissimus dorsi muscle transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial plexus injuries with internal rotational deformity.

  3. Surgical treatment of chronic pulmonary aspergillosis using preventive latissimus dorsi muscle flaps.

    PubMed

    Hata, Yoshinobu; Otsuka, Hajime; Makino, Takashi; Koezuka, Satoshi; Sugino, Keishi; Shiraga, Nobuyuki; Tochigi, Naobumi; Shibuya, Kazutoshi; Homma, Sakae; Iyoda, Akira

    2015-11-05

    Surgery for chronic pulmonary aspergillosis is often technically risky. The choice of immediate thoracoplasty or muscle flap plombage to prevent postoperative space problems remains controversial. This study focused on the use of muscle flaps to prevent postoperative complications. During an 8-year period (2004 to 2012), all patients surgically treated for chronic pulmonary aspergillosis were enrolled in this retrospective study. Concomitant intrathoracic transposition of the latissimus dorsi muscle flap has been performed since 2011. The clinical records of these patients were reviewed retrospectively. From 2004 to 2012, 16 patients were treated for chronic pulmonary aspergillosis. Fifteen patients received lobectomies and one had a partial resection. A preventive latissimus dorsi muscle flap was used in 6 patients (37 %). No postoperative deaths occurred. Prolonged air leaks appeared in 2 patients without muscle flaps, resulting in empyema in both. None of the patients with preventive muscle flaps suffered prolonged air leaks and subsequent empyema. In the outpatient clinic, late onset air leaks developed in 2 patients, one of whom had a lobectomy with muscle flap while the other had a lobectomy without muscle flap. Residual pleural space persisted in these two patients and Aspergillus infection later recurred. Concomitant latissimus dorsi muscle flaps may be effective for the prevention of prolonged air leaks and subsequent empyema. Late onset air leaks are problematic.

  4. Functional Latissimus Dorsi Transfer for Upper-Extremity Reconstruction: A Case Report and Review of the Literature

    PubMed Central

    Therattil, Paul J.; Russo, Gerardo; Lee, Edward S.

    2017-01-01

    Objective: The latissimus dorsi flap is a workhorse for plastic surgeons, being used for many years for soft-tissue coverage of the upper extremity as well as for functional reconstruction to restore motion to the elbow and shoulder. The authors present a case of functional latissimus dorsi transfer for restoration of elbow flexion and review the literature on technique and outcomes. Methods: A literature review was performed using MEDLINE and the Cochrane Collaboration Library for primary research articles on functional latissimus dorsi flap transfer. Data related to surgical techniques and outcomes were extracted. Results: The literature search yielded 13 relevant studies, with a total of 52 patients who received pedicled, functional latissimus dorsi flaps for upper-extremity reconstruction. The most common etiology requiring reconstruction was closed brachial plexus injury (n = 13). After flap transfer, 98% of patients were able to flex the elbow against gravity and 82.3% were able to flex against resistance. In the presented case, a 77-year-old man underwent resection of myxofibrosarcoma of the upper arm with elbow prosthesis placement and functional latissimus dorsi transfer. The patient was able to actively flex against gravity at 3-month follow-up. Conclusions: A review of the literature shows that nearly all patients undergoing functional latissimus dorsi transfer for upper-extremity reconstruction regain at least motion against gravity whereas a large proportion regain motion against resistance. Considerations when planning for functional latissimus dorsi transfer include patient positioning, appropriate tensioning of the muscle, safe inset, polarity, management of other affected upper-extremity joints, and educating patients on the expected outcomes. PMID:28293330

  5. Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation?

    PubMed

    Henseler, Jan Ferdinand; Nagels, Jochem; Nelissen, Rob G H H; de Groot, Jurriaan H

    2014-04-01

    The purpose of this study is to evaluate the muscle activity with surface electromyography (EMG) and the clinical outcome of the latissimus dorsi transfer. It remains unclear whether the clinical results of the latissimus dorsi transfer for massive posterosuperior rotator cuff tears are achieved either by active muscle contractions or by a passive tenodesis effect of the transfer. Eight patients were evaluated preoperatively and at 1 year (SD, 0.1) after the latissimus dorsi transfer. Clinical evaluation of outcomes included active range of motion, Constant score, and visual analog scale (VAS) for pain and activities of daily living (ADL). Muscle activity was recorded with EMG during directional isometric abduction and adduction tasks. The external rotation in adduction improved from 23° to 51° (P = .03). The external rotation in abduction improved from 10° to 70° (P = .02). The mean Constant score improved from 39 to 62 postoperatively (P = .01). The VAS for pain at rest improved from 3.3 preoperatively to 0.1 (P = .02). The VAS for ADL improved from 4.9 to 2.3 (P = .05). The transferred latissimus dorsi remained active in all cases, as reflected by increased latissimus dorsi EMG activity during abduction tasks. In addition, the latissimus dorsi EMG activity shifted from preoperative antagonistic co-activation in adduction to synergistic activation in abduction. The latissimus dorsi has synergistic muscle activity after transfer. Apart from a tenodesis effect, directional muscle activity seems relevant for improved clinical outcome and pain relief. A specific gain was observed for external rotation in elevated arm positions, a motion essential for ADL tasks. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Does Fibrin Sealant Reduce Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap?

    PubMed Central

    Cha, Han Gyu; Shin, Ho Seong; Kang, Moon Seok; Nam, Seung Min

    2012-01-01

    Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent. PMID:23094246

  7. Can angiogenesis induced by chronic electrical stimulation enhance latissimus dorsi muscle flap survival for application in cardiomyoplasty?

    PubMed

    Overgoor, Max L E; Carroll, Sean M; Papanicolau, George; Carroll, Camilla M A; Ustüner, Tuncay E T; Stremel, Richard W; Anderson, Gary L; Franken, Ralph J P M; Kon, Moshe; Barker, John H

    2003-01-01

    In cardiomyoplasty, the latissimus dorsi muscle is lifted on its primary neurovascular pedicle and wrapped around a failing heart. After 2 weeks, it is trained for 6 weeks using chronic electrical stimulation, which transforms the latissimus dorsi muscle into a fatigue-resistant muscle that can contract in synchrony with the beating heart without tiring. In over 600 cardiomyoplasty procedures performed clinically to date, the outcomes have varied. Given the data obtained in animal experiments, the authors believe these variable outcomes are attributable to distal latissimus dorsi muscle flap necrosis. The aim of the present study was to investigate whether the chronic electrical stimulation training used to transform the latissimus dorsi muscle into fatigue-resistant muscle could also be used to induce angiogenesis, increase perfusion, and thus protect the latissimus dorsi muscle flap from distal necrosis. After 14 days of chronic electrical stimulation (10 Hz, 330 microsec, 4 to 6 V continuous, 8 hours/day) of the right or left latissimus dorsi muscle (randomly selected) in 11 rats, both latissimus dorsi muscles were lifted on their thoracodorsal pedicles and returned to their anatomical beds. Four days later, the resulting amount of distal flap necrosis was measured. Also, at predetermined time intervals throughout the experiment, muscle surface blood perfusion was measured using scanning laser Doppler flowmetry. Finally, latissimus dorsi muscles were excised in four additional stimulated rats, to measure angiogenesis (capillary-to-fiber ratio), fiber type (oxidative or glycolytic), and fiber size using histologic specimens. The authors found that chronic electrical stimulation (1) significantly (p < 0.05) increased angiogenesis (mean capillary-to-fiber ratio) by 82 percent and blood perfusion by 36 percent; (2) did not reduce the amount of distal flap necrosis compared with nonchronic electrical stimulation controls (29 +/- 5.3 percent versus 26.6 +/- 5

  8. Influence of psychomotor skills and innervation patterns on results of latissimus dorsi tendon transfer for irreparable rotator cuff tears.

    PubMed

    Werner, Clément M L; Ruckstuhl, Thomas; Müller, Roland; Zanetti, Marco; Gerber, Christian

    2008-01-01

    This investigation was performed to analyze the influence of innervation and psychomotor skills on the outcome of latissimus dorsi transfer. Patients with the 10 best and 10 worst results after latissimus dorsi transfer for irreparable rotator cuff tears were selected. All patients meeting the inclusion criteria (n = 12) were subject to a psychomotor test battery (Motorische Leistungsserie) and electromyographic innervation assessment. There was no statistical difference between the 2 groups preoperatively in terms of the commonly tested factors known to influence the results of this procedure adversely. There was a significant difference in both the pattern and selectivity of innervation in the group that had better clinical results. The psychomotor findings were negatively correlated with the range of motion and the strength of the operative shoulder. Function of the operative shoulder could also be predicted by psychomotor function of the uninjured contralateral side. Psychomotor skills testing appears to be a new, potential method by which to predict the outcome of latissimus dorsi transfer.

  9. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury.

    PubMed

    Friedman, Michael V; Stensby, J Derek; Hillen, Travis J; Demertzis, Jennifer L; Keener, Jay D

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a "muscle up." Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. © 2015 The Author(s).

  10. Double-bellied latissimus dorsi free flap to correct full dental smile palsy.

    PubMed

    Allevi, Fabiana; Motta, Gloria; Colombo, Valeria; Biglioli, Federico

    2015-07-20

    A 45-year-old woman with left facial palsy presented to our department. She developed the condition after radical resection of a neurinoma of the homolateral VIII cranial nerve 2 years prior. On physical examination, a complete palsy of the lower third of the face was reported. Electromyographic examination showed no fibrillation potentials in mimic muscles. A latissimus dorsi muscle free flap (6 cm × 3 cm), split into two bellies linked by their own neurovascular pedicle, was used to restore full-mouth smile. Ten years after surgery, the patient showed a near-natural smile without need of any ancillary procedure. 2015 BMJ Publishing Group Ltd.

  11. Partial mastectomy and m. latissimus dorsi reconstruction for radiation-induced fibrosis after breast-conserving cancer therapy.

    PubMed

    van Geel, Albertus N; Lans, Titia E; Haen, Roel; Tjong Joe Wai, Rudi; Menke-Pluijmers, Marian B E

    2011-03-01

    Patients with severe complaints of radiation-induced fibrosis after breast-conserving therapy and not responding to conservative therapy, were treated by partial mastectomy and m. latissimus dorsi reconstruction. To determine the feasibility and outcome of this approach, a retrospective study of nine patients was carried out. After a mean follow-up of 46 months, eight of the nine patients experienced improvement of their complaints and shape of the breast. In only one case did the procedure fail, as evidenced by continuation of all complaints. Partial mastectomy and m. latissimus dorsi reconstruction is the ultimate option in the treatment of radiation fibrosis. The procedure is safe with satisfying results.

  12. Functional transposition of the latissimus dorsi muscle for biceps reconstruction after upper arm replantation.

    PubMed

    Schoeller, Thomas; Wechselberger, Gottfried; Hussl, Heribert; Huemer, Georg M

    2007-01-01

    Major upper arm amputations are often accompanied by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. In these cases the goal is not only the re-establishment of circulation, but also functional outcome. Some patients require further reconstruction for functional restoration of elbow flexion and additional soft tissue coverage. Five patients underwent functional latissimus dorsi transfer for restoration of elbow flexion after successful upper arm replantation at our institution. The transfer was unipolar in four patients and bipolar in one. The patients' ages ranged from seven to 55 years. The time period between replantation and transfer ranged from two weeks to 12 months. All flaps healed well with minimal donor site morbidity. At mean 43-month follow-up (range: 22-65 months), functional results were good with M4 in three patients and M3 in two patients for elbow flexion. The pedicled latissimus dorsi muscle flap is a valuable tool to restore elbow flexion and provide coverage of soft tissue defects after major upper arm replantations.

  13. Case Report: Modified Latissimus Dorsi Muscle Transfer for Radial Palsy, Presentation of a New Technique

    PubMed Central

    Nazerani, Shahram; Motamedi, Mohammad Hosein Kalantar

    2008-01-01

    Objective: The latissimus dorsi muscle transfer finger and wrist extension is a well-known procedure for patients needing replantation or in brachial plexus injuries. To increase the length of the transferred muscle to reach to the finger and wrist extensors, the other authors suggest extending the muscle length by incorporating the iliac crest fascia, which not only prolongs the operation time but also minimizes the chances of a healthy and viable muscle-tendon junction. We present a modification of the standard latissimus dorsi transfer whereby the whole muscle (not partial harvest) is transferred and extended by tendon graft to minimize the distal muscle-tendon problems and inefficient muscle excursion commonly encountered with the thus far reported techniques. Methods: In a 12-year period (1996–2008), 5 patients were treated. Guidelines for patient selection were (1) complete high radial nerve palsy with no simpler solution to address the problem, (2) supple joints and gliding tendons, (3) good patient motivation, and (4) free muscle transfer not feasible or risky. Results: Five male patients aged 18 to 45 were treated for the absence of wrist and finger extension due to radial nerve damage or extensor group destruction. They were able to use the transferred muscle for extension with minimal training and physiotherapy. Conclusion: (1) Transferring the whole muscle ensures a complete neural arborization and better excursion. (2) It ensures a safe tendon suture wherein the muscle-tendon unit is far from the distal end of the skin flap (less possibility of necrosis). PMID:19165312

  14. Time-dependent changes after latissimus dorsi transfer: tenodesis or tendon transfer?

    PubMed

    Erşen, Ali; Ozben, Hakan; Demirhan, Mehmet; Atalar, Ata Can; Kapıcıoğlu, Mehmet

    2014-12-01

    Transfer of the latissimus dorsi tendon to the posterosuperior part of the rotator cuff is an option in active patients with massive rotator cuff tears to restore shoulder elevation and external rotation. However, it is unknown whether this treatment prevents progression of cuff tear arthropathy. The purpose of this study was to determine whether the observed improvement in shoulder function in the early postoperative period with latissimus dorsi tendon transfer for irreparable rotator cuff tears will be permanent or will deteriorate in the midterm period (at 1-5 years after surgery). During a 6-year period, we performed 11 latissimus dorsi tendon transfers in 11 patients for patients with massive, irreparable, chronic tears of the posterosuperior part of the rotator cuff (defined as > 5 cm supraspinatus and infraspinatus tendon tears with Goutallier Grade 3 to 4 fatty infiltration on MRI), for patients who were younger than 65 years of age, and had high functional demands and intact subscapularis function. No patients were lost to followup; minimum followup was 12 months (median, 33 months; range, 12-62 months). The mean patient age was 55 years (median, 53 years; range, 47-65 years). Shoulder forward elevation, external rotation, and Constant-Murley and American Shoulder and Elbow Surgeons scores were assessed. Pain was assessed by a 0- to 10-point visual analog scale. Acromiohumeral distance and cuff tear arthropathy (staged according to the Hamada classification) were evaluated on radiographs. Shoulder forward elevation, external rotation, Constant-Murley scores, and American Shoulder and Elbow Surgeons scores improved at 6 months. However, although shoulder motion values and Constant-Murley scores remained unchanged between the 6-month and latest evaluations, American Shoulder and Elbow Surgeons scores decreased in this period (median, 71; range, 33-88 versus median, 68; range, 33-85; p = 0.009). Visual analog scale scores improved between the

  15. Autologous breast reconstruction with endoscopic latissimus dorsi musculosubcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance.

    PubMed

    Monticciolo, D L; Ross, D; Bostwick, J; Eaves, F; Styblo, T

    1996-08-01

    The objective of this study was to define and evaluate mammographic changes in patients treated with breast-conserving therapy and a new reconstructive technique that uses autologous tissue from a latissimus dorsi musculosubcutaneous flap. Of 20 patients who underwent either immediate or delayed endoscopic latissimus dorsi muscle flap reconstruction after lumpectomy, 13 also had postsurgery mammograms available for review. Radiographic findings assessed included skin thickening, density or radiolucency at the reconstruction site, density around the flap, fat necrosis, calcifications, and the presence of surgical clips. Mammograms for three patients (23%) revealed thickening that we believed was attributable to radiation therapy. No patient had increased density in the flap itself; all flaps were relatively radiolucent centrally (13/13; 100%). Mammograms revealed density around the rim of the flap in four patients (31%). This density was most likely secondary to latissimus dorsi muscle fibers and did not limit radiographic evaluation. One patient had calcifications, probably secondary to fat necrosis. No oil cysts were seen. In the majority of patients (11/13; 85%), surgical clips were visible. Endoscopic latissimus dorsi muscle flap reconstruction, previously used only for mastectomy patients, is now being used for improved esthetic outcome in selected patients who desire breast conservation. Our results indicate that the mammographic findings are predictable. The most common findings are relative radiolucency centrally, with or without density from muscle fibers around the edges of the area of tissue transfer. The transplanted musculosubcutaneous flap does not interfere with mammographic evaluation.

  16. Pedicled myocutaneous flap of latissimus dorsi muscle for reconstruction of anterior and middle skull defects: an alternative.

    PubMed

    Seckel, B R; Upton, J; Freidberg, S R; Gilbert, K P; Murray, J E

    1986-01-01

    Three cases are presented demonstrating the use of a pedicled myocutaneous flap of latissimus dorsi muscle to reconstruct large defects of the anterior and middle skull after ablative surgery for carcinoma. This method is proposed as an alternative to reconstruction with a free myocutaneous flap in selected patients.

  17. Workhorse Flaps in Chest Wall Reconstruction: The Pectoralis Major, Latissimus Dorsi, and Rectus Abdominis Flaps

    PubMed Central

    Bakri, Karim; Mardini, Samir; Evans, Karen K.; Carlsen, Brian T.; Arnold, Phillip G.

    2011-01-01

    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. PMID:22294942

  18. Chest wall reconstruction in thoracoabdominal ectopia cordis: using the pedicled osteomuscular latissimus dorsi composite flap.

    PubMed

    Lampert, Joshua A; Harmaty, Marco; Thompson, Elizabeth Chabner; Sett, Suvro; Koch, R Michael

    2010-11-01

    Ectopia cordis is a rare congenital defect characterized by complete or partial displacement of the heart outside the thoracic cavity. Repair of ectopia cordis can present a reconstructive challenge often requiring a staged approach. Ideally, structural integrity and protection of the heart are restored using autologous tissues capable of growth. In addition, reconstruction of the thorax must proceed without compromise to pulmonary or cardiovascular stability. The following article describes repair of thoracoabdominal ectopia cordis in a patient with pentalogy of Cantrell. Reconstruction of the chest wall was accomplished using a musculoosseus composite flap involving segments of the 9th and 10th ribs and overlying pedicled latissimus dorsi muscle. This is the first report known to the authors of such a repair.

  19. Complete orbit and forehead reconstruction using a free latissimus dorsi flap and MEDPOR implants.

    PubMed

    Antonopoulos, Dimitrios; Tsiliboti, Dimitra; Skarpetas, Dimitrios; Masmanidis, Aris

    2006-06-01

    Reconstruction of enormous composite defects of the face in the presence of meningitis is a difficult problem. We present a case of a 29-year-old man with a huge, posttraumatic bone and soft tissue defect of the upper half of the left side of the face (orbit-zygoma-frontal-partial temporal bones), frontal lobe of the brain, and enucleated eye with intact facial skin. An initial reconstruction using cement was complicated by multiple episodes of meningitis. In a multiple-stage procedure, we used a free latissimus dorsi muscle flap to re-construct the soft tissue defect and control the infection, a complete left orbit and frontal MEDPOR implant for the bone defect, and also an orbital sphere MEDPOR implant for the eyeball. In a 2-year follow-up, no infection was observed, and the cosmetic result is satisfactory. The combination of free flap and MEDPOR implants demonstrates an alternative method for reconstruction of complicated facial defects.

  20. Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy.

    PubMed

    Koch, Horst; Tomaselli, F; Pierer, G; Schwarzl, F; Haas, F; Smolle-Jüttner, F M; Scharnagl, E

    2002-05-01

    Besides other factors, the choice of reconstructive method for full thickness thoracic wall defects depends on the morbidity of preceding surgical procedures. The pedicled latissimus dorsi flap is a reliable and safe option for reconstruction of the thorax. A posterolateral thoracotomy, however, results in division of the muscle. Both parts of the muscle can be employed to close full thickness defects of the chest wall. The proximal part can be pedicled on the thoracodorsal vessels or the serratus branch; the distal part can be pedicled on paravertebral or intercostal perforators. This retrospective study was undertaken to evaluate the reconstructive potential of both parts of the latissimus dorsi in thoracic wall reconstruction after posterolateral thoracotomy. Between 1987 and 1999, 36 consecutive patients underwent reconstruction of full-thickness thoracic wall defects with latissimus dorsi-flaps after posterolateral thoracotomies. The defects resulted from infection and open window thoracostomy (n=31), trauma (n=3) and resection of tumours (n=2). The patients' average age was 57 years (range 22-76 years). Twenty-five patients were male, 11 were female. In 31 cases the split latissimus dorsi alone was employed; in five cases additional flaps had to be used due to the size of the defects, additional intrathoracic problems or neighbouring defects. In 34 cases defect closure could be achieved without major complications. Empyema recurred in the pleural cavity in one case and one patient died of septicaemia. The 15 patients who had required a respirator in the preoperative phase could be extubated 4.8 days (average) after thoracic wall reconstruction. Postoperative hospital stay averaged 16 days. Different methods are available for reconstruction of full thickness defects of the thoracic wall. After posterolateral thoracotomy in the surgical treatment of empyema, oncologic surgery and traumatology, the latissimus dorsi muscle still retains some reconstructive

  1. Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer.

    PubMed

    Stevanovic, Milan V; Cuéllar, Vanessa G; Ghiassi, Alidad; Sharpe, Frances

    2016-09-01

    In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction.

  2. Immediate breast reconstruction with a Latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery.

    PubMed

    de Oliveira, Riza Rute; do Nascimento, Simony Lira; Derchain, Sophie F M; Sarian, Luís Otávio

    2013-05-01

    Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy. This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up. There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group. The authors' study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion. Therapeutic, II.

  3. [Extra-abdominal desmoid tumor in a scar of donor-site of a latissimus dorsi flap: case report].

    PubMed

    Paradol, P-O; Toussoun, G; Delbaere, M; Delaporte, T; Delay, E

    2008-02-01

    Tumefaction arising lately after latissimus dorsi flap harvest are rare and observed in 1 or 2% of the cases. These lesions are frequently related to kystic sero-hematoma and are easily and efficiently treated with surgical excision. In some rare circumstances, a tumoral evolution can mimic a kystic sero-hematoma. We will discuss one case of desmoid tumor arising from a latissimus dorsi flap donor-site scar. The subject was a 45 years old woman who had a breast reconstruction following mastectomy. A dorsal tumefaction, with a benign aspect, was observed during the follow-up period. The biopsy showed an extra-abdominal desmoid tumor. The patient was treated with a large excision of the lesion and reconstructed using two opposing local cutaneous advancing flaps. No radicalization was necessary. No sign of recurrence has been observed at 4 years follow-up.

  4. Reconstruction of Irradiated Mandible after Segmental Resection of Osteoradionecrosis—A Technique Employing a Microvascular Latissimus Dorsi Flap and Subsequent Particulate Iliac Bone Grafting

    PubMed Central

    Hillerup, Soren; Elberg, Jens Jorgen; Thorn, Jens Jorgen; Andersen, Mikael

    2014-01-01

    The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot. The aim of this study is to present an alternative method of mandibular segmental reconstruction employing a latissimus dorsi (LD) flap and subsequent particulate iliac free bone graft reconstruction. In 15 patients with ORN, a mandibular segmental defect was bridged with a reconstruction plate, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve patients had a subsequent bone grafting from the posterior ileum for repair of defects up to 14 cm length. Three patients had no bone graft for various reasons. In three patients dental rehabilitation was achieved with implant supported prosthodontic appliances. Ten patients met the success criteria of uneventful graft healing with restitution of osseous continuity, mandibular height, symmetry and function, and avoidance of reconstruction plate fracture. PMID:25136407

  5. Availability of latissimus dorsi minigraft in smile reconstruction for incomplete facial paralysis: quantitative assessment based on the optical flow method.

    PubMed

    Takushima, Akihiko; Harii, Kiyonori; Okazaki, Mutsumi; Ohura, Norihiko; Asato, Hirotaka

    2009-04-01

    Acute unilateral facial paralysis, such as occurs in Bell palsy and Hunt syndrome, is mostly a benign neurologic morbidity that resolves within a few months. However, incomplete or misdirected return of the affected nerve results in unfavorable cosmetic sequelae in some patients. Although functional problems such as lagophthalmos are rare, facial asymmetry on smiling resulting from a lack of mimetic muscle strength in the cheek is often psychologically annoying to patients. To obtain a more natural smile, the authors transfer latissimus dorsi muscle to assist in cheek movement. A small, thinned muscle (mini-latissimus dorsi) is sufficient for transplant in this situation. In this study, 96 patients with incomplete facial paralysis who underwent mini-latissimus dorsi transfer were examined. In this series, along with evaluation using the grading scale used in previous reports, preoperative and postoperative videos of 30 patients were analyzed for quantitative assessment using newly developed computer software. Temporary deterioration of paralysis was recognized in three cases but did not last more than a few months. Signs of transferred muscle contraction were recorded after 4 to 12 months among 91 patients. No apparent clinical signs of contraction were recognized in one patient, and four patients could not be followed postoperatively. The synchronized ratio of vertical movement and the symmetrical ratio of horizontal movement both in the cheek and in the lower lip between healthy and paralyzed sides among 30 patients were statistically improved. Statistical analysis using newly developed computer software revealed that a more symmetrical smile can be achieved by muscle transfer among patients with incomplete facial paralysis. Mini-latissimus dorsi transfer can avoid postoperative muscle bulkiness of the cheek and can achieve more natural cheek movement.

  6. Effect of propafenone on the contractile activity of Latissimus dorsi muscle isolated in an organ chamber: experimental study in rats.

    PubMed

    Simões, Ricardo; Machado, Eduardo Luis Guimarães; Freitas, Odilon Gariglio de Alvarenga; Moreira, Maria da Consolação Vieira; Gomes, Otoni Moreira

    2002-03-01

    To study the effect of propafenone on the contractile function of latissimus dorsi muscle isolated from rats in an organ chamber. We studied 20 latissimus dorsi muscles of Wistar rats and divided them into 2 groups: group I (n=10), or control group - we studied the feasibility of muscle contractility; group II (n=10), in which the contralateral muscles were grouped - we analyzed the effect of propafenone on muscle contractility. After building a muscle ring, 8 periods of sequential 2-minute baths were performed, with intervals of preprogrammed electrical stimulation using a pacemaker of 50 stimuli/min. In group II, propafenone, at the concentration of 9.8 microgram/mL, was added to the bath in period 2 and withdrawn in period 4. In group I, no significant depression in muscle contraction occurred up to period 5 (p>0.05). In group II, a significant depression occurred in all periods, except between the last 2 periods (p<0.05). Comparing groups I and II only in period 1, which was a standard period for both groups, we found no significant difference (p>0.05). Propafenone had a depressing effect on the contractile function of latissimus dorsi muscle isolated from rats and studied in an organ chamber.

  7. Bipolar Latissimus Dorsi Transfer for Restoration of Pectoralis Major Function in Poland Syndrome.

    PubMed

    Buchanan, Patrick; Leyngold, Mark; Mast, Bruce A

    2016-01-01

    Poland syndrome typically presents as a unilateral congenital complete or partial absence of the pectoralis major muscle, variably with other associated anomalies. Reconstruction of the defect typically concentrates on aesthetic restoration with functional outcomes being unsuccessful or limited. We present an innovative means of true muscle transfer that provided functional benefit to increase upper extremity strength. A 16-year-old adolescent boy with Poland syndrome manifesting as left pectoralis major muscle agenesis wished to undergo functional reconstruction. He wanted to play on his high school football team, but could not meet the minimum weightlifting requirements. An ipsilateral latissimus dorsi muscle bipolar functional transfer was done with bone-anchored inset into the sternum and humerus so that muscle flexion would replace the absent pectoralis major. A progressive weight training program was then instituted postoperatively. At 9 months, a significant increase in left upper extremity strength was confirmed. The patient ultimately was able to surpass the weightlifting requirements for his high school football team, and joined the team. Our highlighted procedure restored functional outcome using both plastic surgical principles and orthopedic techniques for muscle and tendon repair: bipolar muscle transfer and load-bearing muscle inset. Heretofore, transfer of the latissimus for provision of pectoralis major function has not been reported. Functional reconstruction was possible due to stable, bipolar muscle transfer with load-bearing muscle attachments into cortical bone of the anterior sternum and anteromedial aspect of the humerus. The techniques described should be within the skill set of most plastic surgeons, so that functional restoration for those with Poland syndrome is possible and accessible.

  8. Management and outcomes of latissimus dorsi and teres major injuries in professional baseball pitchers.

    PubMed

    Nagda, Sameer H; Cohen, Steven B; Noonan, Thomas J; Raasch, William G; Ciccotti, Michael G; Yocum, Lewis A

    2011-10-01

    Very little data exist on latissimus dorsi (LD) and teres major (TM) injuries in professional baseball pitchers. This review was undertaken to report on the management and outcomes of baseball pitchers with injury to 1 or both of these muscles. Case series; Level of evidence, 4. A retrospective review of 16 professional baseball pitchers diagnosed and treated for an LD and/or TM tear between 2002 and 2008 was performed. Magnetic resonance imaging confirmed the diagnosis in all cases. The mean age was 28.1 years. All were treated nonoperatively with rest, rehabilitation, and return to pitching after a throwing program. The injuries included tendon avulsions in 6 athletes and strains in 10. Length of disabled time, return to prior level of pitching, and recurrences were noted. Fifteen of 16 pitchers (94%) returned to the same or higher level of play. The mean time to throwing was 35.6 days. Mean time to pitching was 61.9 days. Nine of 16 injuries (56%) were season-ending. Mean total time lost for athletes returning the same season was 82.4 days. Two of 16 pitchers (13%) sustained recurrent injuries. Prior shoulder and elbow injuries were noted in 75% (12 of 16). Injury of the LD and/or TM can occur in pitchers. Nonoperative treatment is successful in allowing a return to high-level pitching.

  9. Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

    PubMed Central

    2017-01-01

    Background: Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging. Methods: Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3). Results: The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred. Conclusions: The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds. PMID:28740770

  10. Novel technique for laparoscopic harvesting of latissimus dorsi flap with prosthesis implantation for breast reconstruction

    PubMed Central

    Xu, Shuman; Tang, Peng; Chen, Xianchun; Yang, Xi; Pan, Qinwen; Gui, Yu; Chen, Li

    2016-01-01

    Abstract Backgroud: An important drawback of the traditional technique for harvesting latissimus dorsi (LD) myocutaneous flap is a long, posterior donor-site incision. Current techniques involve endoscopic or robotic harvesting via a combined approach of open and closed surgery, which necessitates an open axillary incision and the use of special retractors. In this paper, we introduce a fully enclosed laparoscopic technique for harvesting LD flap (LDF) using only 3 small trocar ports. This technique eliminates the need for axillary and donor-site incisions and specialized retractors and considerably reduces the incision size. Methods: We performed laparoscopic harvesting of LDF with prosthesis implantation for immediate breast reconstruction (IBR) after nipple-sparing mastectomy in 2 patients with malignant breast neoplasm who wished to avoid a long scar on the back. Results: IBR using this technique was uneventful in both cases, without any donor-site complications or flap failure. Both patients were satisfied with the esthetic results of the procedure, especially the absence of a visible scar on the back. Conclusion: Enclosed laparoscopic harvesting of LDF is simpler and less invasive than the traditional methods. These preliminary results warrant further evaluation in a larger population to validate the benefits of this technique. PMID:27861385

  11. Breast reconstruction in low resource settings: Autologous latissimus dorsi flap provides a viable option.

    PubMed

    Kaur, N; Gupta, A; Saini, S

    2015-01-01

    Breast reconstruction (BR) plays a significant role in the woman's physical, emotional and psychological recovery from breast cancer. However, the current most accepted methods of reconstruction are expensive, may require microsurgical skills and can be offered to a very small number of patients seeking treatment in tertiary care centers. For the large majority of women seeking treatment in public hospitals, solution lies in finding a method of reconstruction, which is autologous, produces a reasonable match to the contralateral breast in size, shape and symmetry and produces minimal donor site morbidity. It should also be a technique, which is cost effective and can withstand the effects of radiotherapy (RT). The autologous latissimus dorsi (LD) flap is one such versatile technique, which can serve as an ideal reconstructive option for the majority of patients. During a period of 6 years, 19 patients underwent immediate BR using this flap in the Department of General Surgery. Patients who were young (mean age 37.4 years), had small to medium sized breasts, with operable breast cancer (Stage II and IIIa) were selected for the procedure. Satisfactory cosmetic results as rated by patients as well as surgeons were achieved in the majority. Donor site morbidities were seroma formation (78%) and donor site wound breakdown (21%). Post-operative RT was well-tolerated by the reconstructed breast. Autologous LD flap reconstruction is a safe and economical option for BR in low resource settings and is suitable for women with small and medium sized breasts.

  12. Serratus anterior venous tributary as a second outflow vein in latissimus dorsi free flaps.

    PubMed

    Goh, Terence; Tan, Bien-Keem; Ong, Yee-Siang; Chew, Winston

    2011-10-01

    The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (N = 1), the long saphenous vein (N = 2), a deep vein (N= 1), and to a deep vein via a vein graft (N = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm(2) (10 × 15 cm) to 260 cm(2) (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat.

  13. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap.

    PubMed

    Homma, Tsutomu; Okazaki, Mutsumi; Tanaka, Kentaro; Uemura, Noriko

    2017-07-01

    Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.

  14. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap

    PubMed Central

    Okazaki, Mutsumi; Tanaka, Kentaro; Uemura, Noriko

    2017-01-01

    Summary: Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis. PMID:28831334

  15. The pedicled latissimus dorsi flap in head and neck reconstruction: an old method revisited.

    PubMed

    Wilkman, Tommy; Suominen, Sinikka; Back, Leif; Vuola, Jyrki; Lassus, Patrik

    2014-03-01

    In head and neck cancer patients with significant comorbidities, the reconstructive options are limited, and there is a need for a safe alternative for microvascular flaps without compromising flap size. During the study period, 331 head and neck cancer patients were reconstructed with microvascular tissue flaps. Ten patients requiring large resections were considered to have high risks for long surgery and to be poor candidates for free tissue transfer and thus were reconstructed with a subpectorally tunneled pedicled latissimus dorsi (SP-LD) flap. The flap was raised simultaneously with the tumor resection and tunneled to the head and neck region. The flap was used for reconstruction of oral, mandibular, pharyngeal, or neck defects. Median follow-up was 3.6 years. Median duration of surgery was 7 hours and 17 minutes, and total hospital stay was 20 days. During the follow-up, four patients died of their disease and one from another cause (median of 329 days). We were able to perform large tumor resections with a curative intent and reconstruct major defects in high-risk head and neck cancer patients with a SP-LD flap. It possesses many of the characteristics of a free flap with the benefits of a shorter operation time and less perioperative risk.

  16. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

    PubMed

    Longo, Benedetto; Laporta, Rosaria; Pagnoni, Marco; Campanale, Antonella; Grippaudo, Francesca Romana; Santanelli Di Pompeo, Fabio

    2015-03-01

    Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

  17. Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right.

    PubMed

    Feng, Jiajun; Pardoe, Cleone I; Mota, Ashley Manuel; Chui, Christopher Hoe Kong; Tan, Bien-Keem

    2016-03-01

    The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

  18. Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity.

    PubMed

    van Huizum, Martine A; Hoornweg, Marije J; de Ruiter, Noor; Oudenhoven, Erik; Hage, J Joris; Veeger, Dirk Jan

    2016-08-01

    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. 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. 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. 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.

  19. Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study.

    PubMed

    Lorenzetti, Fulvio; Giordano, Salvatore; Tukiainen, Erkki

    2012-05-01

    The aim of this study was to assess intraoperatively the hemodynamic changes in the donor vessel of free latissimus dorsi (LD) flap before and after denervation and to analyze flow changes after flap transfer. Twenty-seven patients underwent LD muscle microvascular reconstruction for lower-limb soft tissue defects. Measurements of blood flow were performed intraoperatively by using a 2- to 5-mm probe ultrasonic transit-time flowmeter around the dissected vessels. Registrations were made in the thoracodorsal artery before and after harvesting the flap, after compressing and cutting the motor nerve, and after anastomosis. Mean blood flow of in situ harvested thoracodorsal artery as measured intraoperatively by transit-time flowmeter was (mean ± standard deviation) 16.6 ± 11 mL/min and was significantly increased after raising the flap to 24.0 ± 22 mL/min (p <0.05); it was 25.6 ± 23 mL/min after compressing the motor nerve and was significantly increased after cutting the motor nerve to 32.5 ± 26 mL/min (p <0.05). A significant increase of blood flow to 28.1 ± 19 mL/min was also detected in the thoracodorsal artery after flap transplantation with end-to-side anastomosis (p <0.05). Vascular resistance in the thoracodorsal artery significantly decreased after flap raising and anastomosis (from 7.5 ± 3.4 to 4.0 ± 1.9 and to 4.5 ± 2.4, respectively, p <0.05). LD flap harvesting increases blood flow and decreases resistance in the thoracodorsal artery, especially after denervation.

  20. Effects of high intensity canoeing training on fibre area and fibre type in the latissimus dorsi muscle.

    PubMed Central

    Baker, S J; Hardy, L

    1989-01-01

    A high intensity short duration exercise training programme was undertaken by nine subjects on three occasions each week for nine weeks. Muscle samples from the latissimus dorsi were taken by needle biopsy, at rest, before and after training. The results revealed that there was no change in either Type I or Type II muscle fibre distribution following training. Type I fibre area did not alter significantly as a result of the training stress. Mean cross-sectional area of Type II fibres was 82 per cent greater post-training than pre-training. Images Figure 1 Figure 2 PMID:2730995

  1. [Evaluation of patients' satisfaction after breast reconstruction with latissimus dorsi myocutaneous flap and immediate permanent breast implant].

    PubMed

    Bognár, Gábor; Gőgh, Bettina; Novák, András; István, Gábor

    2014-04-01

    Current surgical treatment modalities for breast reconstruction include latissimus dorsi mycotaneous flap with immediate permanent breast implant (LDI). The aim of the present study was to analyze reconstruction with LDI in terms of quality of life, cosmesis and patient satisfaction. A chart analysis was carried out with the first ten patients who underwent breast reconstruction with LDI. The patients were interviewed and self-assessment quality of life was administered. They also underwent assessment of satisfaction and cosmesis. The high satisfaction and cosmesis scores in the breast reconstruction group indicate the superior results that can be achieved with breast reconstruction.

  2. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back.

    PubMed

    Serra-Renom, José M; Serra-Mestre, José M; Martinez, Lourdes; D'Andrea, Francesco

    2013-10-01

    Results obtained with breast-conserving therapy are not always satisfactory. Reconstruction with a pure latissimus dorsi muscle flap is a useful option. The techniques described for endoscopic dissection of the flap create several scars on the back. As a result, they do not improve on the open approach, which causes a horizontal scar at the level of the bra strap. The authors' technique avoids all scars on the back using a single incision in the highest folds of the axilla, which also is used for the sentinel node biopsy or lymphadectomy and quadrantectomy. The study was performed with 23 patients. The tumor was extracted via a clockwise downward periareolar incision and via another incision in a fold of the axilla. Through this axillary incision, the sentinel lymph node biopsy or lymphadectomy was performed, and the external part of the latissimus dorsi muscle was harvested endoscopically for the reconstruction. Both the medical team and the patients reported high satisfaction with the aesthetic and functional results due to the preservation of the breast shape and the absence of any scarring on the back. Endoscopy-assisted techniques make either three small scars on the back or one long scar, with the muscle sectioned distally, or a vertical incision in the midaxillary line, which may form a hypertrophic or keloid scar. The authors' approach avoids the creation of these scars on the back because the endoscopy and the distal sectioning of the muscle flap are performed through the single axillary incision.

  3. Obstetric paralysis: anterior arthroscopic release of the shoulder and transfer of the latissimus dorsi using a homologous graft.

    PubMed

    Miyazaki, Alberto Naoki; Checchia, Caio Santos; Checchia, Sergio Luiz; Fregoneze, Marcelo; Santos, Pedro Doneux; do Val Sella, Guilherme

    2016-01-01

    Description of a new surgical technique for treating the shoulders of patients with sequelae of obstetric paralysis. Preliminary analysis on the results obtained from this technique. Five consecutive patients underwent the proposed surgical procedure, consisting of arthroscopic anterior joint release followed by transfer of the latissimus dorsi tendon (elongated and reinforced with a homologous tendon graft) to the posterosuperior portion of the greater tubercle, using a single deltopectoral approach. All the patients were reevaluated after a minimum postoperative period of twelve months. The functional assessment was based on the range of motion and the modified Mallet classification system. Statistical analyses were not possible because of the small sample. Overall, passive and active lateral rotations increased, while medial rotation decreased. The other movements (elevation, capacity to place a hand in the mouth and capacity to place a hand behind the neck) had less consistent evolution. The mean modified Mallet score improved by 4.2 points (from 11.4 to 15.6). The latissimus dorsi tendon can be transferred to the posterosuperior portion of the greater tubercle through a single deltopectoral approach when elongated and reinforced with a homologous tendinous graft.

  4. Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate.

    PubMed

    Samuel, Madan; Parapurath, Rajiv

    2016-02-01

    Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete congenital diaphragmatic agenesis using a combination of autologous living bio-tissue and synthetic mesh in a neonate born in the NMC Specialty Hospital in Dubai, United Arab Emirates, in May 2014. Poor Apgar scores, a scaphoid abdomen and absent breath sounds over the right hemithorax were observed at birth. Chest and abdominal X-rays revealed a diaphragmatic hernia. The neonate was stabilised using high-frequency oscillatory ventilation, nitric oxide and sildenafil. The right diaphragm was reconstructed using combined latissimus dorsi and serratus anterior muscle flaps reinforced by a flexible composite mesh. At 12 months old, the infant had normal respiratory function and the diaphragm was intact. No disabilities of the shoulder or scapula were observed. This case indicates that a combination of living tissue and synthetic mesh can be used to reconstruct a functional diaphragm with efficient pleuroperitoneal separation.

  5. Double chamber ventricular assist device with a roller screw linear actuator driven by left and right latissimus dorsi muscles.

    PubMed

    Takatani, S; Takami, Y; Nakazawa, T; Jacobs, G; Nose, Y

    1995-01-01

    A double chamber ventricular assist device (VAD) with a roller screw linear muscle actuator (RSLMA) driven by the left and right latissimus dorsi muscles was developed. The inflow port of each chamber was connected to form the compound inflow port, and the outflow ports were connected to form the compound outflow port. The advantages of this system include 1) the contraction of each muscle contributes to ejection from each ventricle into the common outflow port, thus doubling the net outflow; 2) through proper adjustment of muscle length, the preload to each muscle can be optimized to yield the maximum muscle force; 3) muscle can be stimulated at a lower rate to reduce fatigue and to optimize muscle performance; and 4) the compliance chamber needed in the implantable VAD system is not required with this system. In vitro evaluation in the mock loop with the human arm actuating the RSLMA revealed that the double chamber VAD can provide pump flows of 2-4 L/min against an afterload of 100 mmHg at a stimulation rate of 35-50 beats per minute. The power requirement for each muscle ranged from 2.5 to 3 W at a muscle stroke length of 4 cm. These results verify that the double chamber VAD with the RSLMA driven by the left and right latissimus dorsi muscles can meet the design requirements of a muscle driven VAD to assist the left heart.

  6. Latissimus Dorsi Tendon Transfer with GraftJacket® Augmentation to Increase Tendon Length for an Irreparable Rotator Cuff Tear

    PubMed Central

    2017-01-01

    Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT). Although uncommon, the natural length of the latissimus dorsi tendon (LDT) could be insufficient for transfer even after adequate soft tissue releases. Descriptions of cases where grafts were needed to lengthen the LDT are therefore rare. We located only two reports of the use of an acellular dermal matrix to increase effective tendon length in tendon transfers about the shoulder: (1) GraftJacket patch for a pectoralis major tendon reconstruction and (2) ArthroFlex® patch for LDTT. Both of these brands of allograft patches are obtained from human cadavers. These products are usually used to cover soft tissue repairs and offer supplemental support rather than for increasing tendon length. Extending the LDTT with GraftJacket to achieve adequate length, to our knowledge, has not been reported in the literature. We report the case of a 50-year-old male who had a massive, irreparable left shoulder rotator cuff tear that was reconstructed with a LDTT. The natural length of his LDT was insufficient for transfer. This unexpected situation was rectified by sewing two patches of GraftJacket to the LDT. The patient had greatly improved shoulder function at two-year follow-up. PMID:28194290

  7. Vascular delay of the latissimus dorsi provides an early hemodynamic benefit in dynamic cardiomyoplasty.

    PubMed

    Ali, A T; Santamore, W P; Chiang, B Y; Dowling, R D; Tobin, G R; Slater, A D

    1999-05-01

    Dynamic cardiomyoplasty (CMP) as a surgical treatment for chronic heart failure improves functional class status for most patients. However, significant hemodynamic improvement with latissimus dorsi muscle (LDM) stimulation has not been consistent. The current protocols do not allow early LDM stimulation after CMP surgery. We hypothesized that vascular delay of LDM would increase myocardial assistance after CMP and allow early (48-h) LDM stimulation after CMP. Mongrel dogs (n = 24) were divided in four groups: 1) controls (n = 6), single-stage CMP; 2) Group ES (n = 6), single-stage CMP with early LDM stimulation beginning 48 h, postoperatively; 3) Group VD (n = 6), vascular delay of the LDM followed by CMP without early LDM stimulation, and 4) Group VDES (n = 6), vascular delay of LDM (14-18 days), followed by CMP with early stimulation (48 h postoperatively). Two weeks after CMP, global cardiac dysfunction was induced by injecting microspheres into the left coronary artery. LDM-assisted (S) beats were compared with nonstimulated beats (NS) by measuring aortic pressure (AoP), LV pressure, aortic flow, and by calculating first derivative of LV contraction (+/-dP/dt), stroke volume (SV), and stroke work (SW). In ES, LDM stimulation had no effect on the hemodynamic parameters. In the other groups, LDM stimulation significantly (p < 0.05) increased AoP, LVP, dP/dt, SV, and SW. However, these increases were much larger in VD and VDES. In VD, LDM stimulation increased peak AoP by 21.5+/-3.8 mm Hg, LVP by 22.1+/-4.1 mm Hg, dP/dt by 512+/-163 mm Hg/sec, SV by 10.4+/-2.3 mL, and SW by 22.1+/-5.4 g/m(-1). Similarly, in VDES, LDM stimulation increased peak AoP by 24.1+/-4.7 mm Hg, LVP by 26.2+/-4.3 mm Hg, dP/dt by 619+/-47 mm Hg/sec, SV by 6.5+/-0.7 mL, and SW by 16.7+/-4.1 g/m(-1). In dogs with global LV dysfunction, CMP after vascular delay resulted in a significant improvement in hemodynamic function measured 2 weeks after surgery. This improvement was not provided by

  8. Hydraulic pouches of canine latissimus dorsi. Potential for left ventricular assistance.

    PubMed

    Mannion, J D; Hammond, R; Stephenson, L W

    1986-04-01

    We have studied the fatigue rates of hydraulic pouches constructed in the form of a multilayered conical spiral using the latissimus dorsi muscle of 17 beagles. The roles that electrical muscle conditioning and early interruption of collateral blood supply have in the prevention of pouch fatigue were evaluated. The length of time that a pouch could generate flow in a hydraulic test system was measured; afterload was set at 80 mm Hg and preload 24 mm Hg. Pouches (N = 3) fashioned from muscles subject to neither electrical conditioning nor a vascular delay generated an initial flow of 990 +/- 346 ml/min, but could sustain flow for only 2.3, 3.8 and 3.6 minutes. Pouches (N = 5) constructed with electrically unconditioned muscles after a vascular delay (median 3 weeks) demonstrated a variable improvement in fatigue rates (initial flow 826 +/- 265 ml/min; time to no forward flow, 2.5, 7.5, 7.5, 10, and 200 minutes). Four of six pouches that received the benefit of long-term electrical muscle conditioning and a vascular delay (N = 6) were able to generate flow for a 4 hour period, at which time the experiment was terminated (initial flow 478 +/- 204 ml/min; final flow 195 +/- 157 ml/min). After the 4 hour fatigue test was completed, one electrically conditioned pouch was placed in series with the heart and served as a counterpulsator. The initial volume of blood pumped by the muscle pouch was 262 ml/min or 13.8% of cardiac output. After the pouch had contracted at a rate of approximately 45 beats/min for 1 hour, the volume of blood pumped was 178 ml/min, or 11% of cardiac output. In three other animals a pouch was fashioned and then left in situ for a 1 to 3 week period before hydraulic testing. These pouches generated significant initial flows (390 +/- 60 ml/min), which demonstrates the feasibility of further study of permanent pouches. These results suggest that permanent electrical muscle conditioning and perhaps a vascular collateral delay might permit an auxiliary

  9. Influence of fixation point of latissimus dorsi tendon transfer for irreparable rotator cuff tear on glenohumeral external rotation: A cadaver study.

    PubMed

    Bargoin, K; Boissard, M; Kany, J; Grimberg, J

    2016-12-01

    Latissimus dorsi tendon transfer is a surgical option for treating irreparable posterosuperior rotator cuff tears, notably when attempting to reconstruct active external rotation. We hypothesized that the positioning of the transfer's point of fixation would differ depending on the desired elbow-to-body external rotation or external rotation with the elbow abducted. Seven shoulders from four whole frozen cadavers were used. We created two systems to install the subject in a semi-seated position to allow external rotation elbow to body and the arm abducted 90°. Traction sutures were positioned on the latissimus dorsi muscle and a massive tear of the rotator cuff was created. We tested six different transfer positions. Muscle contraction of the latissimus dorsi was stimulated using 10-N and 20-N suspended weights. The point of fixation of the latissimus dorsi on the humeral head had an influence on the elbow-to-body external rotation and with 90° abduction (P<0.001). The fixation point for a maximum external rotation with the elbow to the body was the anterolateral position (P<0.016). The fixation point for a maximum external rotation at 90° abduction was the position centered on the infraspinatus footprint (P<0.078). The optimal point of fixation differs depending on whether external rotation is restored at 0° or 90° abduction. Fundamental study, anatomic study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

    PubMed

    Iglesias, Martin; Gonzalez-Chapa, Diego R

    2013-08-01

    Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the

  11. Pyoderma gangrenosum following complex reconstruction of a large-scale lower limb defect by combined Parascapular and latissimus dorsi flap

    PubMed Central

    Cordts, Tomke; Bigdeli, Amir K.; Harhaus, Leila; Hirche, Christoph; Kremer, Thomas; Kneser, Ulrich; Schmidt, Volker J.

    2017-01-01

    A female patient with a critical soft tissue defect after elective knee replacement surgery was transferred to our department for reconstruction. As wounds were rapidly progressing, necrotizing fasciitis was initially suspected but eventually ruled out by histopathological analysis. A 50 × 15 cm defect was then reconstructed by means of a combined Parascapular and latissimus dorsi flap before, a couple days later, the patient developed tender pustules and ulcers involving the flap as well as the donor site. Attempts of excising necrotic areas not only continued to fail but seemed to worsen the patient's wound and overall condition. Eventually, pyoderma gangrenosum (PG) was diagnosed and local and systemic therapy was initiated but treatment proved to be challenging and insufficient at first. Being an extremely aggressive disease, early diagnosis is crucial and PG should always be suspected when rapidly progressive ulceration on surgical sites is observed. PMID:28096323

  12. Bipolar Latissimus Dorsi Transfer through a Single Incision: First Key-Step in Poland Syndrome Chest Deformity.

    PubMed

    Watfa, William; di Summa, Pietro G; Raffoul, Wassim

    2016-08-01

    Poland syndrome is a rare congenital anomaly characterized by a unilateral congenital absence of the sternocostal head of the pectoralis major muscle. The absence of the pectoralis major does not only result in chest asymmetry but also in a missing anterior axillary fold, which is essential for natural anatomical appearance in both male and female patients. In Poland syndrome patients, we perform bipolar latissimus dorsi flap transfer, which can be associated with a sublatissimus implant in women. All procedures are performed through a single short midaxillary incision, and tendon translocation in this technique allows the creation of the anterior axillary fold and thus a natural chest appearance. Moreover, this technique can be performed by any plastic surgeon operating under a basic operating room setting.

  13. Use of latissimus dorsi muscle onlay patch alternative to acellular dermal matrix in implant-based breast reconstruction

    PubMed Central

    Lee, Jeeyeon

    2015-01-01

    Background An acellular dermal matrix (ADM) is applied to release the surrounding muscles and prevent dislocation or rippling of the implant. We compared implant-based breast reconstruction using the latissimus dorsi (LD) muscle, referred to as an “LD muscle onlay patch,” with using an ADM. Method A total of 56 patients (60 breasts) underwent nipple sparing mastectomy with implant-based breast reconstruction using an ADM or LD muscle onlay patch. Cosmetic outcomes were assessed 4 weeks after chemotherapy or radiotherapy, and statistical analyses were performed. Results Mean surgical time and hospital stay were significantly longer in the LD muscle onlay patch group than the ADM group. However, there were no statistically significant differences between groups in postoperative complications. Cosmetic outcomes for breast symmetry and shape were higher in the LD muscle onlay patch group. Conclusions Implant-based breast reconstruction with an LD muscle onlay patch would be a feasible alternative to using an ADM. PMID:26161312

  14. Bipolar Latissimus Dorsi Transfer through a Single Incision: First Key–Step in Poland Syndrome Chest Deformity

    PubMed Central

    di Summa, Pietro G.; Raffoul, Wassim

    2016-01-01

    Summary: Poland syndrome is a rare congenital anomaly characterized by a unilateral congenital absence of the sternocostal head of the pectoralis major muscle. The absence of the pectoralis major does not only result in chest asymmetry but also in a missing anterior axillary fold, which is essential for natural anatomical appearance in both male and female patients. In Poland syndrome patients, we perform bipolar latissimus dorsi flap transfer, which can be associated with a sublatissimus implant in women. All procedures are performed through a single short midaxillary incision, and tendon translocation in this technique allows the creation of the anterior axillary fold and thus a natural chest appearance. Moreover, this technique can be performed by any plastic surgeon operating under a basic operating room setting. PMID:27622115

  15. The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence.

    PubMed

    Garusi, Cristina; Lohsiriwat, Visnu; Brenelli, Fabricio; Galimberti, Viviana Enrica; De Lorenzi, Francesca; Rietjens, Mario; Rossetto, Fabio; Petit, Jean Yves

    2011-04-01

    Total mastectomy is usually indicated after breast conservative treatment cancer recurrence. Breast reconstruction in this group can be performed with many options. We did 63 latissimus dorsi flap with implants reconstructions between 2001-2007. All of them were performed in breast cancer recurrence cases after breast conservative treatment and preceded for total mastectomy. The patient age range from 31 to 71 years old (50.1 ± 7.3 years). The follow-up was 36.5 ± 14.9 months (22-141 months). Neither flap loss nor significant major donor-site complication was recorded. The capsular contraction Baker's grade III was observed in 2 cases (3.1%). The rest were grade I-II and there was no grade IV contracture. We purpose that LD flap with implant can be performed in irradiated breast with low capsular contracture rate. It is suitable in total mastectomy reconstruction after conservative breast cancer surgery recurrence.

  16. [The use of the myocutaneous flap of m. latissimus dorsi in reconstructive maxillofacial surgery. An analysis and the technical considerations of 42 cases].

    PubMed

    Iriarte Ortabe, J I; Reychler, H

    1992-01-01

    The AA. report their experience about 42 of latissimus dorsi flaps, used in the maxillofacial reconstruction of 40 patients, during the last 4 years. After a brief historic and anatomic descriptions, the operative technique used for them is detailed with the solution for the encountered problems. The discussion of the advantages and drawbacks of this flap which should deserve a preferential place in the reconstructive surgery of large losses of the maxillofacial sphere (besides the microsurgical methods) ends the paper.

  17. Use of latissimus dorsi pedicled myocutaneous flap for reconstruction in the chest area of an 8-month-old female infant with ectopia cordis.

    PubMed

    Dastagir, Khaled; Breymann, Thomas; Heckmann, Andreas; Horke, Alexander; Vogt, Peter Maria

    2014-12-01

    Ectopia cordis (EC) is characterized by a complete or partial malposition of the heart outside the thorax. Despite the interdisciplinary treatment, the repair of EC is still very difficult and offers new surgical challenges because of its complexity and various combinations with other anomalies. We report the successful outcome after using a pedicled latissimus dorsi flap in reconstructive surgery in the setting of chronic wound dehiscence in an 8-month-old female infant born with a thoracic EC and omphalocele.

  18. Use of Latissimus Dorsi Pedicled Myocutaneous Flap for Reconstruction in the Chest Area of an 8-Month-Old Female Infant with Ectopia Cordis

    PubMed Central

    Dastagir, Khaled; Breymann, Thomas; Heckmann, Andreas; Horke, Alexander; Vogt, Peter Maria

    2014-01-01

    Ectopia cordis (EC) is characterized by a complete or partial malposition of the heart outside the thorax. Despite the interdisciplinary treatment, the repair of EC is still very difficult and offers new surgical challenges because of its complexity and various combinations with other anomalies. We report the successful outcome after using a pedicled latissimus dorsi flap in reconstructive surgery in the setting of chronic wound dehiscence in an 8-month-old female infant born with a thoracic EC and omphalocele. PMID:25798359

  19. Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer

    PubMed Central

    Cuéllar, Vanessa G.; Ghiassi, Alidad; Sharpe, Frances

    2016-01-01

    Introduction: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Methods: Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Results: Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. Conclusions: This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm. PMID:27757363

  20. The scapular, parascapular, and latissimus dorsi flap as a single osteomyocutaneous flap for repair of complex oral defects.

    PubMed

    Janus, Jeffrey R; Carlson, Matthew L; Moore, Eric J

    2012-01-01

    Complex composite defects of the oral cavity are often created due to en bloc resection of malignant tumors. These defects can involve bone, soft tissue, oral mucosa, and external skin, posing a reconstructive challenge to the microvascular surgeon. Though advances have been made in free tissue transfer via piggybacking techniques and double free-flaps, increases in operative time and morbidity remain limiting factors. Likewise, advancements in single composite flaps (e.g., double-skin paddle fibular free-flap) allow for a single donor site, but limit workable tissue. This report describes our experience with the scapular, parascapular, and latissimus dorsi (SPLD) as a combined single unit osteomyocutaneous flap for composite reconstruction of complex oral defects. A case example is subsequently reviewed for clinical correlation. This is an operative techniques article describing the use of the SPLD single multi-tissue flap for repair of complex oral defects. Cadaveric dissection was performed for instructional purposes. Case example was given for clinical correlation. Relevant history, anatomy, procedural details, and possible complications are presented and subsequently correlated to the case example. A SPLD free-flap as a single multi-tissue flap is a viable and beneficial option for reconstruction of complex oral defects. It provides the volume of tissue necessary to fill composite defects and exists as an alternative to multi-flap procedures, which carry a longer operative time and multiple donor site morbidity.

  1. Elbow Reconstruction With Compression Plate Arthrodesis and Circumferential Muscle-Sparing Latissimus Dorsi Flap After Tumor Resection

    PubMed Central

    Ng, Zhi Yang; Ramachandran, Savitha; Tan, Bien-Keem; Foo, Leon; Ng, Siew-Weng

    2016-01-01

    Background: The goals of limb-sparing surgery in the setting of extremity malignancies are 2-fold: oncological clearance and the rehabilitation of function and aesthetics. Treatment success should be defined by the extent of restoration of the patient’s premorbid function for reintegration into society. Methods: We would like to report an unusual case of a patient with a chronically ankylosed elbow with joint invasion by basal cell carcinoma which resulted from malignant transformation of an overlying, long-standing wound due to inadequately treated septic arthritis from his childhood years. Results: Following R0 resection, upper limb shortening and compression plate elbow arthrodesis were performed with the aim of restoring the degree of upper limb function that the patient had been accustomed to preoperatively. The resultant circumferential defect was then closed with a contralateral, free muscle-sparing latissimus dorsi flap. Conclusions: Functional preservation may therefore be more important than the mere restoration of anatomical defects in these especially challenging situations. PMID:27418897

  2. Anatomical Research of the Three-dimensional Route of the Thoracodorsal Nerve, Artery, and Veins in Latissimus Dorsi Muscle

    PubMed Central

    Takahashi, Nagahiro; Watanabe, Koichi; Koga, Noriyuki; Rikimaru, Hideaki; Saga, Tsuyoshi; Nakamura, Moriyoshi; Tabira, Yoko; Yamaki, Koh-ichi

    2013-01-01

    Background: The latissimus dorsi (LD) muscle flap has been widely used in facial reanimation surgery. However, there are no standards to what degree the muscle flap may be safely thinned because the three-dimensional positional relationship of thoracodorsal artery, vein, and nerve inside the LD muscle is poorly understood. Methods: From 18 formalin-fixed cadavers, we made 36 transparent specimens of LD muscles using a newly developed decoloration technique. In 26 specimens, nerve staining (Sihler’s staining method) and silicone rubber (Microfil) injection to the thoracodorsal artery were performed, and the relationship of the artery and the vein was examined in 10 specimens. Results: The thoracodorsal artery and vein always ran parallel in a deeper layer compared to the nerve. The thoracodorsal nerve constantly existed in a deeper layer than half (50%) of the muscle in the range of use of the muscle flap in facial reanimation surgery. Conclusions: The thoracodorsal nerves ran in a shallower layer, and the depth to the nerve in the muscle flap in actual facial reanimation surgery is safe enough to avoid damage to the nerves. The LD muscle may be thinned to half its original thickness safely. PMID:25289214

  3. Neo-phalloplasty with re-innervated latissimus dorsi free flap: a functional study of a novel technique.

    PubMed

    Ranno, R; Veselý, J; Hýza, P; Stupka, I; Justan, I; Dvorák, Z; Monni, N; Novák, P; Ranno, S

    2007-01-01

    Twenty two patients with gender dysphoria underwent neo-phalloplasties using a novel technique. Latissimus dorsi musculocutaneus re-innervated free flap was used to allow voluntary rigidity of the neo-penis. From the first 22 patients, 18 have obtained motoric function of reconstructed penis; the "paradox erection" was obtained. 14 patients came for examination after a follow-up period of mean 26.4 months. We evaluated the motility and shape changes of neo-phallus measuring its different size and dimension during relax and muscle contraction. The range of neo-phallus length in relaxed position was between 7 and 17 cm (mean 12.2 cm), its circumference in the same position had a range between 13 and 20 cm (mean 13.7 cm). All patients were able to contract the muscle with an average length reduction of 3.08 cm and an average circumference enlargement of 4 cm. In this study, the dimensions and motility were quantified demonstrating the neo-phallus function and size changes during sexual intercourse.

  4. The use of a pedunculated, extended latissimus dorsi flap in primary and secondary breast reconstruction procedures--case report.

    PubMed

    Maciejewski, Adam; Ulczok, Rafał; Dobrut, Mirosław; Szumniak, Ryszard; Półtorak, Stanisław

    2012-07-01

    The extended latissimus dorsi flap (LD) is used in breast reconstruction since the 70's. LD flap is often used in corrective surgery in cases of unsatisfactory cosmetic results after breast-conserving therapy. In our department LD flap has several uses. In addition to free microvascular flaps - which applies in breast reconstructive surgery is routine, there are clinical situations where the use of pedicled LD flap is justified. The main indications for its use are: the inability to apply microvascular flap, the general condition (diabetes, advanced atherosclerosis), smoking, previous surgery of abdominal wall, abdominal obesity, patient preferences. Approximately 30% of patients after breast reconstruction require corrective procedures. Group which uses extended LD flap account for 24 patients. In 16 cases it was used for elective breast reconstruction. In the remaining eight cases it was used in the corrective procedures symmetry and shape of the previously reconstructed breast. Based on our own experience it can be concluded that the LD flap with an alternative to microvascular techniques. Complication rate when using the LD flap is relatively low and includes: seroma and slight motor disability of the shoulder girdle.

  5. Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study - Combining DASH score and objective evaluation.

    PubMed

    Garusi, C; Manconi, A; Lanni, G; Lomeo, G; Loschi, P; Simoncini, M C; Santoro, L; Rietjens, M; Petit, J Y

    2016-06-01

    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. 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. 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. Focusing this data, a growing, "disability-free" percentage changes depending on whether or not the patients have practiced sport could be appreciate. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction.

    PubMed

    Boa, Olivier; Servant, Jean-Marie; Revol, Marc; Salib, Emmanuel G; Guberman, Daniel; Harris, Patrick G; Danino, Alain M

    2011-09-01

    The latissimus dorsi, whether taken as a muscle or with a skin paddle, is one of the most useful flaps in the reconstructive surgeon's arsenal. With its predictable type V vascular pedicle, this broad muscle can be elevated on its dominant thoracodorsal pedicle or used in a reverse manner on its secondary thoracic and lumbar perforators. Traditionally harvested in a lateral decubitus position, over the last 10 years we have chosen to elevate this muscle in a dorsal decubitus position, enabling 2 surgical teams to operate simultaneously. With only one cushion placed along the vertebral column between the scapulas, each element of the subscapular system, including scapular bone, can be used to reconstruct complex upper limb defects. A vertical incision in front of the anterior axillary line is performed to identify the anterior border of the muscle, followed by a dissection in the submuscular plane to reveal the thoracodorsal pedicle and its branches. When a more complex chimeric flap is required, scapular bone, serratus muscle, and scapular or parascapular fasciocutaneous flaps are all available. To achieve the longest length possible, the pedicle can be isolated from the axillary vessels. The most common complications are related to donor site, with seroma and delayed wound healing being the most prevalent. Complaints of shoulder pain and functional disability were rare and mostly encountered in the first 2 weeks postoperatively.

  7. Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: A systematic review.

    PubMed

    Wey, Aaron; Dunn, John C; Kusnezov, Nicholas; Waterman, Brian R; Kilcoyne, Kelly G

    2017-01-01

    In conjunction with reverse total shoulder arthroplasty (RSA), latissimus dorsi and teres major (LD-TM) transfer has been advocated in the setting of combined loss of elevation and external rotation. The purpose of this systematic review is to summarize the clinical outcomes following RSA with LD-TM transfer. A search of PubMed, EMBASE, CINAHL, Medline, and Cochrane databases was performed between January 1, 1990 and March 1, 2016 and included articles related to outcomes following RSA with LD-TM transfer. Primary outcomes of interest were constant score, shoulder range of motion, and patient satisfaction. Secondary outcomes of interest included subjective shoulder value, simple shoulder test, activities of daily living requiring external rotation, and visual analog pain score. Additional outcomes evaluated included complications and reoperations. Frequency-weighted values of outcome data were utilized. Five level IV studies involving 98 shoulders met the inclusion criteria. The mean age of the cohort was 69.1 ± 5.19 years (range 47-85). RSA with LD-TM transfer was performed for rotator cuff arthropathy (94%) or proximal humerus fracture (6%). The average follow-up was 44.5 ± 10.38 months (range 12-105 months). The constant score improved from 28 to 65 ( p < 0.0005). Active external rotation improved from -7.4° to 22.9° ( p < 0.0005). There was a 22.4% overall complication rate, including dislocation (5.1%), infection (5.1%), and transient nerve palsy (3.4%). Patients undergoing RSA with LD-TM transfer in the setting of loss of external rotation demonstrate reliable clinical improvements in shoulder function with complication rates which are comparable to RSA alone.

  8. Oncological safety and quality of life associated with mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap.

    PubMed

    Min, Sun Young; Kim, Hyun Yul; Jung, So-Youn; Kwon, Youngmee; Shin, Kyung Hwan; Lee, Seeyoun; Kim, Seok Won; Kang, Han-Sung; Yun, Young Ho; Lee, Eun Sook

    2010-01-01

    To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, 1,699 had breast-conserving surgery (BCS) and 120 had a mastectomy with an immediate LD. We retrospectively compared the oncologic safety of the two techniques. We also assessed the QoL using the EORTC QLQ BR-23 and Zung's self-rating depression scale in 52 LD patients, 104 age- and stage-matched patients who underwent BCS, and 104 age-matched healthy women. The LD group had earlier stage disease than the BCS group at baseline, but following surgery, the groups did not differ in the rates of local recurrence or systemic metastases. Compared with the healthy group, the patient groups had poorer functioning and more depression (p < 0.001). Among the patient groups, the LD group reported lower scores for body image (p = 0.007) and future perspective (p = 0.023) than the BCS group. In the LD group, patients who received neoadjuvant chemotherapy reported lower scores for future perspective and higher scores for depression than those who did not receive neoadjuvant chemotherapy (p < 0.001). The BCS and LD groups did not differ in oncological outcome, and the QoL of patients in the LD group was not always good. Mastectomy with immediate reconstruction should be considered carefully and tailored to the patient's needs and characteristics.

  9. The role of pectoralis major and latissimus dorsi muscles in a biomechanical model of massive rotator cuff tear.

    PubMed

    Campbell, Sean T; Ecklund, Kier J; Chu, Eileen H; McGarry, Michelle H; Gupta, Ranjan; Lee, Thay Q

    2014-08-01

    Superior migration of the humeral head after massive rotator cuff tear (mRCT) is thought to lead to cuff tear arthropathy. Previous biomechanical studies have demonstrated the ability of the pectoralis major and latissimus dorsi (PM/LD) muscles to resist this migration. This study examined the role of PM/LD muscles on glenohumeral joint forces and acromiohumeral contact pressures in a mRCT model. Six cadaveric shoulders were tested using a custom shoulder-testing system. Muscle insertions of the rotator cuff, deltoid, and PM/LD were preserved and used for muscle loading. Specimens were tested in 3 different humeral rotation positions at 0° abduction and 2 rotation positions at 60° abduction. Testing was performed for intact specimens, after supraspinatus removal, and after supraspinatus/infraspinatus/teres minor removal. PM/LD were loaded or unloaded to determine their effect. Humeral head kinematics, glenohumeral joint forces, and acromiohumeral contact area and pressure were measured. For the mRCT condition at 0° abduction, unloading the PM/LD resulted in superior shift of the humeral head. Acromiohumeral contact pressures were undetectable when the PM/LD were loaded but increased significantly after PM/LD unloading. After mRCT, superior joint forces were increased and compressive forces were decreased compared with intact; loading the PM/LD resolved these abnormal forces in some testing conditions. In mRCT, the PM and LD muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. Strengthening or neuromuscular training of this musculature, or both, may delay the progression to cuff tear arthropathy. Published by Mosby, Inc.

  10. Physical and Functional Ability Recovery Patterns and Quality of Life after Immediate Autologous Latissimus Dorsi Breast Reconstruction: A 1-Year Prospective Observational Study.

    PubMed

    Yang, Jung Dug; Huh, Jin Seok; Min, Yu-Sun; Kim, Hyo Jin; Park, Ho Yong; Jung, Tae-Du

    2015-12-01

    The authors evaluated arm and shoulder function and quality of life prospectively after breast reconstruction with the latissimus dorsi flap. Muscle strength was checked by manual muscle test and range of motion preoperatively and then at five postoperative time points: week 2, week 6, month 3, month 6, and month 12. Functional disability and quality of life were also measured by the Disabilities of the Arm, Shoulder and Hand questionnaire and the 36-Item Short-Form Health Survey. The assessments were performed preoperatively and then at three postoperative time-points (i.e., months 3, 6, and 12). Statistical analysis was performed by repeated-measures analysis of variance. Thirty-one patients were included for analysis. All manual muscle test and range-of-motion scale scores at postoperative week 2 decreased significantly compared with preoperative scores. After postoperative month 3, scores for both manual muscle test and range of motion nearly recovered to preoperative status. However, functional disability, according to the Disabilities of the Arm, Shoulder and Hand instrument, was increased considerably after latissimus dorsi flap surgery, and a substantial amount of disability remained 1 year postoperatively. The mental component of the 36-Item Short-Form Health Survey improved consistently for 1 year postoperatively, whereas the physical component decreased significantly until the sixth month postoperatively and was still lower than the preoperative score at postoperative month 12. One year after latissimus dorsi flap surgery, shoulder strength and range of motion returned to baseline. However, functional disability and deteriorated physical aspects of quality of life persisted.

  11. Latissimus dorsi/rib intercostal perforator myo-osseocutaneous free flap reconstruction in composite defects of the scalp: case series and review of literature.

    PubMed

    Seitz, Iris A; Adler, Neta; Odessey, Eric; Reid, Russell R; Gottlieb, Lawrence J

    2009-11-01

    Adequate coverage of complex, composite scalp defects in previously radiated, infected, or otherwise compromised tissue represents a challenge in reconstructive surgery. To provide wound closure with bony protection to the brain, improve cranial contour, and prevent or seal cerebrospinal fluid (CSF) leaks, composite free tissue transfer is a reliable and safe option. We report our experience with the latissimus dorsi/rib intercostal perforator myo-osseocutaneous free flap in the reconstruction of bony and soft tissue defects of the cranium and overlying scalp. The surgical technique, design, and outcomes of the latissimus dorsi/rib intercostal perforator myo-osseocutaneous free flap reconstruction in five patients with cranial defects between 2003 and 2007 were retrospectively evaluated. Patient characteristics, defect size, underlying cause, reconstructive details, and complications were analyzed. All patients (age 43 to 81) had composite defects ranging from 36 to 750 cm2 (mean size 230 cm2) for the bony component and from 16 to 400 cm2 (mean size 170 cm2) for the soft tissue defect. All patients had a history of prior or current infection of the affected area, and two patients had a CSF leak. Defects were due to malignancy and infection (n = 2), infiltrative cutaneous mucormycosis with osteomyelitis (n = 1), and hemorrhagic stroke requiring craniectomy (n = 2), complicated by infection and failed cranioplasty in one patient and continuous CSF leak in the other. The latissimus dorsi composite free flap consisting of skin, muscle, and vascularized rib can successfully cover large complex cranial defects, provide skeletal support, improve contour, and significantly enhance functional outcome with limited donor site morbidity. Copyright Thieme Medical Publishers.

  12. [Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

    PubMed

    Lanfrey, E; Grolleau, J L; Glock, Y; Chavoin, J P; Costagliola, M

    1996-04-01

    Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials.

  13. The use of autologous platelet-leukocyte-enriched plasma to minimize drain burden and prevent seroma formation in latissimus dorsi breast reconstruction.

    PubMed

    Harper, J Garrett; Elliott, L Franklyn; Bergey, Patti

    2012-05-01

    Seromas and drains are major sources of morbidity associated with latissimus dorsi breast reconstruction. Our goal was to look at an autologous platelet-leukocyte-enriched plasma spray and to assess its efficacy in reducing drain burden and seroma formation. We performed a single surgeon, patient-controlled, blinded study on bilateral latissimus dorsi breast reconstruction patients in which we applied autologous platelet-leukocyte-enriched plasma to one side and measured drain amounts, time to drain removal, and seroma rate. Twelve patients were included in this study. The average age was 41.1 years, and the average body mass index was 21.6 kg/m. Average volume of drain output showed neither difference (789 mL spray side vs. 790 mL control side) nor average time to drain removal (11.83 days spray side vs. 11.5 days control side). There were 2 complications reported: 1 hematoma (8.33%) and 1 seroma (8.33%) that required aspiration in a postoperative visit. It appears after 12 patients that there is no demonstrable difference regarding drain output, time to drain removal, or seroma incidence between the study and the control group. We feel a larger study population would add power and confirm these findings.

  14. Reconstruction of large defect of foot with extensive bone loss exclusively using a latissimus dorsi muscle free flap: a potential new indication for this flap.

    PubMed

    Gomez, Manuel Macemino; Casal, Diogo

    2012-01-01

    In cases of extensive damage to the foot, with significant bone loss, it is generally accepted that reconstruction must include bone flaps or grafts either in the emergency setting or subsequently. In this report, we describe the case of an 18-year-old student with an avulsion injury of the dorsum of his right foot. Consequently, he lost most of the soft tissue over the dorsum of the foot and the cuboid, navicular, and cuneiform bones. A latissimus dorsi free flap was used to reconstruct the defect. A functional pseudoarthrosis developed between the remaining bones of the foot, and the patient experienced satisfactory foot function after rehabilitation. For this reason, no additional reconstructive procedure was undertaken. This case suggests that it might be adequate to use the latissimus dorsi muscle flap more liberally than previously reported in the reconstruction of extensive defects of the dorsum of the foot, including cases with significant bone loss. This option could avoid the morbidity and inconvenience of a second surgery and the need to harvest a bone flap or graft.

  15. Repair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report.

    PubMed

    Turgut, Gursel; Kayalı, Mahmut Ulvi; Köse, Ozkan; Baş, Lütfü

    2010-12-01

    Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would not be feasible, the lower limb can be salvaged with a cross-leg free flap procedure. We present a case with a large composite tissue loss that was reconstructed with cross-leg free transfer of a combined latissimus dorsi and serratus anterior muscle flap. This case indicates that this large muscle flap can survive with the cross-leg free flap method and this technique may be a viable alternative for large lower extremity defects that have no reliable recipient artery.

  16. Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus☆

    PubMed Central

    de Moraes, Frederico Barra; Kwae, Mário Yoshihide; da Silva, Ricardo Pereira; Porto, Celmo Celeno; de Paiva Magalhães, Daniel; Paulino, Matheus Veloso

    2015-01-01

    Objective To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. Methods This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal–Wallis tests were used (p < 0.05). Results The patients’ mean age was 32 years (range: 17–56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 (p = 0.1). Conclusion The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used. PMID:27218077

  17. Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears.

    PubMed

    Castricini, Roberto; De Benedetto, Massimo; Familiari, Filippo; De Gori, Marco; De Nardo, Pasquale; Orlando, Nicola; Gasparini, Giorgio; Galasso, Olimpio

    2016-04-01

    Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors. The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up. As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes. Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy.

    PubMed

    Sowa, Yoshihiro; Morihara, Toru; Kushida, Rie; Sakaguchi, Koichi; Taguchi, Tetsuya; Numajiri, Toshiaki

    2017-05-01

    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). 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. 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. 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.

  19. Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (LDT).

    PubMed

    Ippolito, Giorgio; Serrao, Mariano; Napoli, Francesco; Conte, Carmela; Miscusi, Massimo; Coppola, Gianluca; Pierelli, Francesco; Costanzo, Giuseppe; De Cupis, Vincenzo

    2016-10-01

    Latissimus dorsi tendon transfer (LDT) is a recent method for surgical treatment of massive, irreparable posterosuperior cuff tears (MIPCT). So far, there are no studies on the quantitative motion analysis of the shoulder and latissimus dorsi (LD) muscle activation after LDT. The changes in shoulder movements after LDT can be objectively assessed by the 3-D motion analysis. These changes may not be due to an increased activity of the LD muscle as external rotator. The shoulder kinematics of nine patients with MIPCT were recorded through a 3-D motion analysis system, before LTD (T0), and after 3 (T1) and 6 (T2) months post-LDT. Maximal shoulder flexion-extension, abduction-adduction, and horizontal abduction-adduction, and the internal and external circumduction of the shoulder joint were measured during upright standing posture. Surface EMG activity of the LD muscle was recorded during both internal rotation (IR) and external rotation (ER) tasks in three different postures. A significant increase of shoulder movements was observed at T2 compared with T0 for almost all motor tasks. A significant effect of LDT was also found on LD-IR/ER ratio in posture 1 at T2 compared with T0 and T1. No significant effects were found for the LD-IR/ER ratio in the other postures. Our study indicates that LDT is effective in shoulder motion recovery. Such improvement is not associated with a change in function of the LD muscle, which may be induced by a depression of the humeral head into the glenoid cavity instead.

  20. Single step fibula-pro-tibia transfer and soft tissue coverage with free myocutaneous latissimus dorsi flap after extensive osteomyelitis and soft tissue necrosis--a 3 year follow up.

    PubMed

    Föhn, M; Bannasch, H; Stark, G B

    2009-11-01

    A 10-year-old girl from Ghana, Africa, developed chronic osteomyelitis of her right tibia and a large soft tissue defect on the ventral lower leg after a minor injury. She was treated more than 6 months after trauma without any improvement. We report a follow up of 3 years after reconstruction with a single-step pedicled fibula-pro-tibia transfer and wound coverage with a free myocutaneous latissimus dorsi flap.

  1. [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].

    PubMed

    Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C

    2016-11-17

    The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision.

  2. One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis.

    PubMed

    Okazaki, Mutsumi; Mutsumi, Okazaki; Kentaro, Tanaka; Noriko, Uemura; Satoshi, Usami; Tsutomu, Homma; Alisa, Okubo; Mayuko, Hamanaga; Hiroki, Mori

    2015-06-01

    Various types of neurovascular free-muscle transfers have been reported as surgical treatments for long-standing facial paralysis. Among one-stage methods, two approaches, that is, latissimus dorsi transfer with nerve suturing to the contralateral facial nerve and gracilis transfer with nerve suturing to the ipsilateral masseteric nerve, have recently become popular. The former method has the advantage of making spontaneous smiling possible, but the contraction strength of the transferred muscle varies, whereas the latter approach has the advantage of guaranteeing voluntary contraction of the transferred muscle, but makes spontaneous smiling difficult. Recently, dual innervation methods have also been reported, but uncertainty remains about the utility of such approaches. To overcome these drawbacks, we devised a hybrid method combining the two previously established techniques. Two latissimus dorsi muscle flaps containing the thoracodorsal vessels from one side are transferred with a pair of vascular anastomoses. The true trunk of the thoracodorsal nerve, which innervates one of the muscle flaps, is sutured to the contralateral facial nerve, while the short branch of the thoracodorsal nerve, which innervates the other muscle flap, is sutured to the ipsilateral masseteric nerve. From November 2011 to October 2013, we used this method in four patients with long-standing facial paralysis. Smiling was assessed in the three patients who were followed up for more than 1 year, and satisfactory results were obtained (Harii score: 4-5). In one patient, the movement mediated via the contralateral facial nerve was a little weak, but this was compensated for by the muscles controlled by the ipsilateral masseteric nerve. Our novel one-stage method, which involves a combination of two previously established methods, guarantees early voluntary smiling, and spontaneous smiling becomes possible later. In addition, it is free from the uncertainty associated with double innervation

  3. Patient-reported outcomes and their predictors at 2- and 3-year follow-up after immediate latissimus dorsi breast reconstruction and adjuvant treatment.

    PubMed

    Winters, Z E; Afzal, M; Balta, V; Freeman, J; Llewellyn-Bennett, R; Rayter, Z; Cook, J; Greenwood, R; King, M T

    2016-04-01

    The aim of this study was to estimate the impact 2 and 3 years after surgery of implant-assisted latissimus dorsi (LDI) and autologous latissimus dorsi (ALD) flap breast reconstructions on patient-reported outcomes (PROs), and, secondarily, to determine whether baseline characteristics can predict PROs. This was a multicentre prospective cohort study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and breast cancer module (QLQ-BR23), Functional Assessment of Cancer Therapy - Breast (FACT-B), and Hospital Anxiety and Depression Scale (HADS) PROs were completed before surgery and at 2 and 3 years after breast reconstruction. The effects of LDI and ALD, adjusted for baseline clinicodemographic characteristics, were estimated with multiple linear regressions. Effect sizes above 0·5 were considered clinically important. Some 206 patients (LDI 93, ALD 113) were recruited in 2007-2013; 66·5 per cent were node-negative and 34·6 per cent received radiotherapy. Women with adverse clinicopathological factors were more likely to have received radiotherapy and to undergo ALD. Patients in both surgical groups showed clinically important effects at 2 and 3 years, including improvements in emotional scales, but worse physical functioning, social well-being, body image and anxiety. Radiotherapy adversely affected social functioning at 2 years (P = 0·002). Women undergoing ALD reconstruction had significantly improved sexual functioning at 3 years (P = 0·003) relative to those who had LDI procedures, even after adjusting for case mix (P = 0·007). At 3 years, younger women experienced worse physical well-being than older women (P = 0·006), and chemotherapy was associated with worse arm symptoms (P = 0·005). Clinically important changes occurred in physical functioning, breast symptoms, body image and psychological distress. These results will guide selections of key PRO

  4. [Repair of lower extremity soft tissue defect with free musculo-cutaneous flaps bridging with healthy contralateral posterior tibial vessel].

    PubMed

    Chengde, Xia; Haiping, Di; Jidong, Xue; Yaohua, Zhao; Xiaoliang, Li; Qiang, Li; Xihua, Niu; Yonglin, Li; Hongkai, Lian

    2015-05-01

    To observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect. From February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting. All the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered. Appropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

  5. Use of latissimus dorsi flap pedicle as a T-junction to facilitate simultaneous free fibular flap inset in lower extremity salvage.

    PubMed

    Hwang, Kyu Tae; Youn, Seungki; Kim, Jeong Tae; Lee, Seung Hoon; Ng, Siew-Weng; Kim, Youn Hwan

    2012-04-01

    Marjolin's ulcer is a very aggressive form of squamous cell carcinoma arising from chronic wounds or unstable scars. A resection margin of at least 2 cm with clear deep margin is required on removal. A 79-year-old male presented with chronic osteomyelitis of the left anterior tibial region with chronic ulceration. Biopsy revealed squamous cell carcinoma. The tumour, measuring 8 cm, was resected with surrounding unstable scar tissue including en bloc resection of the involved tibial bone, leaving the posterior cortex. Reconstruction was done with a fibular free flap from the contralateral side, but the pedicle length was too short to reach the anterior tibial vessels. To bridge the vascular gap, and to cover the soft-tissue defect, a latissimus dorsi free flap was harvested using the muscle-sparing method. The thoracodorsal vessels were used as an interpositional graft to anastomose the peroneal vessels of the fibular flap. The patient was ambulatory by 4 months, and complete bone union was seen after 6 months. During the 18-month follow-up period, there was no evidence of recurrence.

  6. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema.

    PubMed

    Nicoli, Fabio; Orfaniotis, Georgios; Lazzeri, Davide; Lim, Seong Yoon; Kiranantawat, Kidakorn; Chen, Pei-Yu; Ciudad, Pedro; Chilgar, Ram M; Sapountzis, Stamatis; Sacak, Bulent; Chen, Hung-Chi

    2016-11-01

    Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016. © 2015 Wiley Periodicals, Inc.

  7. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up

    PubMed Central

    Ortiz-Dominguez, Abel

    2016-01-01

    Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112

  8. Novel technique for laparoscopic harvesting of latissimus dorsi flap with prosthesis implantation for breast reconstruction: A preliminary study with 2 case reports.

    PubMed

    Xu, Shuman; Tang, Peng; Chen, Xianchun; Yang, Xi; Pan, Qinwen; Gui, Yu; Chen, Li

    2016-11-01

    An important drawback of the traditional technique for harvesting latissimus dorsi (LD) myocutaneous flap is a long, posterior donor-site incision. Current techniques involve endoscopic or robotic harvesting via a combined approach of open and closed surgery, which necessitates an open axillary incision and the use of special retractors. In this paper, we introduce a fully enclosed laparoscopic technique for harvesting LD flap (LDF) using only 3 small trocar ports. This technique eliminates the need for axillary and donor-site incisions and specialized retractors and considerably reduces the incision size. We performed laparoscopic harvesting of LDF with prosthesis implantation for immediate breast reconstruction (IBR) after nipple-sparing mastectomy in 2 patients with malignant breast neoplasm who wished to avoid a long scar on the back. IBR using this technique was uneventful in both cases, without any donor-site complications or flap failure. Both patients were satisfied with the esthetic results of the procedure, especially the absence of a visible scar on the back. Enclosed laparoscopic harvesting of LDF is simpler and less invasive than the traditional methods. These preliminary results warrant further evaluation in a larger population to validate the benefits of this technique.

  9. Immediate breast reconstruction with transverse latissimus dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy.

    PubMed

    de Oliveira, Riza Rute; Pinto e Silva, Marcela Ponzio; Gurgel, Maria Salete Costa; Pastori-Filho, Leo; Sarian, Luís Otávio

    2010-04-01

    Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latissimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.

  10. Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap.

    PubMed

    Ludolph, Ingo; Apel, Hendrik; Horch, Raymund E; Beier, Justus P

    2014-11-01

    We present a surgical treatment for bladder reconstruction in a case of chronic vesicocutaneous radiation-induced fistula and reconstruction of the abdominal wall after resection of a liposarcoma in the rectus abdominis muscle. Fistulas are sequelae after radiotherapy. To regain bladder function and reconstitute abdominal wall stability, a microsurgical flap approach should be considered. A male patient underwent resection of a liposarcoma in the rectus abdominis muscle with adjuvant radiotherapy, suffering from a chronic vesicocutaneous fistula. A bipedicled combined latissimus dorsi and serratus anterior flap was carried out after resection of the fistula for reconstruction of the urine bladder and the abdominal wall. Ascending urethrography 4 weeks postoperatively showed no leakage. In the 4-month follow-up period, no signs of recurrence of the fistula or herniation occurred. A bipedicled flap allowed reconstruction of the urine bladder and the abdominal wall. Using non-irradiated, well-perfused intra-abdominal muscle tissue over the urine bladder prevented recurrence of the fistula.

  11. The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review.

    PubMed

    Blackburn, N E; Mc Veigh, J G; Mc Caughan, E; Wilson, I M

    2017-02-10

    Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

  12. Recovery of sensation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps after breast-conservative surgery and skin-sparing mastectomy.

    PubMed

    Tomita, Koichi; Yano, Kenji; Hosokawa, Ko

    2011-04-01

    In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

  13. A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle

    PubMed Central

    Konarik, Marek; Kachlik, David; Baca, Vaclav

    2014-01-01

    A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus. PMID:25428677

  14. A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle.

    PubMed

    Konarik, Marek; Kachlik, David; Baca, Vaclav

    2014-09-11

    A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the "radial artery with high origin"). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

  15. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up.

    PubMed

    Olvera-Caballero, Carlos; Ortiz-Dominguez, Abel

    2016-08-01

    A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results.

  16. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region.

    PubMed

    Horn, Dominik; Jonas, Rene; Engel, Michael; Freier, Kolja; Hoffmann, Jürgen; Freudlsperger, Christian

    2014-12-01

    Tailoring the most suitable reconstructive approach to each patient remains challenging especially in the head and neck region. To compare the applicability of the latissimus dorsi (LD) and anterolateral thigh (ALT) flap, we retrospectively analyzed patients who had reconstruction of extensive and/or bulky composite tissue defects in the head and neck area. We performed 85 free tissue transfers (44 LD and 41 ALT flaps). LD mean flap surface was 115.8 cm(2). ALT mean flap surface was 67.0 cm(2). Pedicle length ranged from 8 to 16 cm in LD and 11-16 cm in ALT flaps. The survival rate was 93% in ALT and 91% in LD flaps. Donor site morbidity occurred in 5% (ALT) and 7% (LD). A Two-team-approach was possible in 24% of the LD group, whereas all ALT flaps were raised in a Two-team-approach. Both flaps present excellent opportunities for the reconstruction of extensive and/or bulky defects. They largely meet the requirements of an ideal soft tissue flap in terms of versatility, skin texture and tissue stock. Both flaps can be raised with a double skin paddle. The advantages and disadvantages of each flap have to be weighed up against each other and both flaps should be in the repertoire of every microvascular surgeon.

  17. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    PubMed

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.

  18. Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

    PubMed Central

    2012-01-01

    Background Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed. Methods Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction. Results The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction. Conclusions Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation. PMID:23192102

  19. Ex vivo evaluation of a roller screw linear muscle actuator for an implantable ventricular assist device using trained and untrained latissimus dorsi muscles.

    PubMed

    Sasaki, Y; Chikazawa, G; Nogawa, M; Nishida, H; Koyanagi, H; Takatani, S

    1999-03-01

    In this study, the power output and contraction length of trained and untrained canine latissimus dorsi (LD) muscles were measured using a roller screw linear muscle actuator (RSLMA). The RSLMA consisted of a roller screw-nut assembly and translation unit to convert the linear pull force of the muscle into an axial displacement of the roller screw. When a cable wound around a spool attached at each end of the roller screw nut was pulled in either direction, the nut was rotated which in turn advanced the roller screw in the axial direction. Under anesthesia, a Telectronics myostimulator (Model 7220) was implanted in the subcutaneous area of the canine left thoracic region with its bipolar intramuscular leads implanted around the thoracodorsal nerve and the distal muscle. A total of 6 dogs went through the myostimulator implantation, followed with 8 weeks of continuous stimulation. After completion of the training, the contraction lengths of the trained and untrained LD muscles were measured, and they were 4.25 and 5.5 cm, respectively, while the instantaneous power outputs were 4.24 and 8 W, respectively. Although untrained muscles could provide much higher instantaneous power immediately following the start of the stimulation, it diminished rapidly. On the other hand, the trained muscle showed prolonged fatigue resistance. The thoracolumbar and humeral approaches in attaching the actuator cable did not show a difference with respect to muscle power output. The trained LD muscle can provide sufficient power in the range of 3-4 W to drive a left heart assist device, but its long-term evaluation awaits development of an appropriate muscle-device interface for chronic in vivo application.

  20. Male papillary breast cancer treated by wide resection and latissimus dorsi flap reconstruction: A case report and review of the literature

    PubMed Central

    Banys-Paluchowski, Malgorzata; Burandt, Eike; Banys, Joanna; Geist, Stefan; Sauter, Guido; Krawczyk, Natalia; Paluchowski, Peter

    2016-01-01

    Breast cancer (BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors (both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical (non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; pT3 (10 cm), pN0 (0/15), M0, R0; OncotypeDX Recurrence Score indicated low risk (RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required. PMID:27777885

  1. Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study.

    PubMed

    Prasad, Vani; Almutairi, Khalid; Kimble, Frank W; Stewart, Fiona; Morris, Steven F

    2012-11-01

    The posterior intercostal artery (PICA) is divided into four segments, vertebral, costal, intermuscular, and rectus, based on the neurovascular branching pattern. Dorsal branches arise from the vertebral segment. Several musculocutaneous perforators and a lateral branch originate from the costal segment. Musculocutaneous branches arise from the intermuscular and rectus segments. The purpose of this study is to describe in detail the musculocutaneous perforators of the costal segment of the posterior intercostal artery. Fresh cadavers were injected with a modified lead oxide-gelatin mixture. Intercostal spaces (8-11) were dissected in twelve cadavers (six preserved cadavers and six fresh cadavers). Angiograms were assembled with Adobe Photoshop. Two fresh cadavers underwent CT angiography and three dimensional reconstructions of the intercostal perforators were performed using Materialise's Interactive Medical Image Control System (MIMICS). In twelve cadavers, a total of 356 perforators (size > 0.5 mm) were found to arise from the posterior intercostal arteries in 96 intercostal (IC) spaces. 154 perforators (>0.5 mm) were found in the costal segment of the PICA. An average of 6.4 perforators was found in each hemithorax. All perforators were found within 2 cm of the midscapular line. At least one perforator was found in all intercostal spaces. Two or more perforators were found in 40% of the 8th and 9th IC spaces and 60% of the 10th and 11th IC spaces. Perforators were oriented perpendicular to the direction of the muscle fibres of the latissimus dorsi and were usually present one or two intercostal spaces below their origin from the PICA. Perforators of the costal segment of the PICA are described in detail. We propose to call these currently unnamed musculocutaneous perforators "dorsolateral" branches of the PICA, as they are located between dorsal and lateral branches of PICA. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  2. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.

    PubMed

    Al-Qattan, M M

    2001-02-01

    A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce Wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. Median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.

  3. Reconstruction of a large calvarial traumatic defect using a custom-made porous hydroxyapatite implant covered by a free latissimus dorsi muscle flap in an 11-year-old patient.

    PubMed

    Morice, Anne; Kolb, Frédéric; Picard, Arnaud; Kadlub, Natacha; Puget, Stéphanie

    2017-01-01

    Reconstruction of complex skull defects requires collaboration between neurosurgeons and plastic surgeons to choose the most appropriate procedure, especially in growing children. The authors describe herein the reconstruction of an extensive traumatic bone and soft tissue defect of the cranial vault in an 11-year-old boy. The size of the defect, quality of the tissues, and patient's initial condition required a 2-stage approach. Ten months after an initial emergency procedure in which lacerated bone and soft tissue were excised, reconstruction was performed. The bone defect, situated on the left frontoparietal region, was 85 cm(2) and was filled by a custom-made porous hydroxyapatite implant. The quality of the overlying soft tissue did not allow the use of classic local and locoregional coverage techniques. A free latissimus dorsi muscle flap branched on the contralateral superficial temporal pedicle was used and left for secondary healing to take advantage of scar retraction and to minimize alopecia. Stable well-vascularized implant coverage as well as an esthetically pleasing skull shape was achieved. Results in this case suggest that concomitant reconstruction of large calvarial defects by cranioplasty with a custom-made hydroxyapatite implant covered by a free latissimus dorsi muscle flap is a safe and efficient procedure in children, provided that there is no underlying infection of the operative site.

  4. Fibrin Sealants and Quilting Suture for Prevention of Seroma Formation Following Latissimus Dorsi Muscle Harvest: A Systematic Review and Meta-analysis.

    PubMed

    Lee, Kyeong-Tae; Mun, Goo-Hyun

    2015-06-01

    Despite popular use of fibrin sealants and quilting sutures for prevention of seroma formation at the donor site of the latissimus dorsi (LD) muscle flap, there is still no consensus regarding their efficacy. The present review estimates the potential benefits of fibrin and quilting suture for reducing seroma-related morbidity following LD muscle harvest. Using Medline, Ovid, and Cochrane databases, two-arm studies evaluating the efficacy of fibrin sealants, quilting suture, or their combination for prevention of seroma formation following LD muscle transfer were searched. The outcome measure was the incidence of seroma, total drainage volume from the back, periods of drainage in situ, volume of seroma, and frequency of aspiration for treatment of seroma. The efficacy on reducing the seroma-related morbidity for each procedure was estimated by meta-analytic methodology. Fourteen studies were analyzed. Fibrin alone failed to reduce seroma-related morbidities compared with no intervention, while fibrin instillation combined with quilting suture halved the risk of seroma formation (relative risk (RR): 0.51, 95 % CI 0.12-2.16) and significantly reduced total drainage volume (mean difference (MD); -320.80, 95 % CI -389.92 to -251.68) and drain indwelling periods (MD -1.62, 95 % CI -2.91 to -0.33) compared with quilting suture alone. Quilting suture had significant protective effects on reducing the risk of seroma formation (RR 0.38, 95 % CI 0.19-0.75), total drainage volume (MD -284.10, 95 % CI -474.61 to -93.60), and drain indwelling periods (MD -3.65, 95 % CI -5.43 to -1.87), and its efficacy was enhanced by combining with fibrin. According to this review, both fibrin and quilting sutures contributed in varying degrees to reducing seroma-related morbidity following LD muscle transfer, and their combination can have a synergistic effect. Although large-scaled, randomized studies are needed, the combination of both procedures may be considered an effective option for

  5. Tissue oxygen tension measurement for monitoring musculocutaneous and cutaneous flaps.

    PubMed

    Hjortdal, V E; Awwad, A M; Gottrup, F; Kirkegaard, L; Gellett, S

    1990-01-01

    In pigs, latissimus dorsi musculocutaneous island flaps and buttock skin island flaps were raised. Subcutaneous (PscO2) and intramuscular oxygen tension (PimO2) were measured using a non-heated needle electrode before, during and after repeated occlusion of the supplying artery or the draining vein. During arterial and venous occlusion, the tissue oxygen tension in the musculocutaneous flap dropped rapidly. A plateau was reached after 15 min. After arterial occlusion the mean value was 20 mmHg (SEM = +/- 5 mmHg, N = 6) in the subcutis and 16 mmHg in the muscle (SEM = +/- 4 mmHg, N = 10). After venous occlusion the mean value was 11 mmHg (SEM = +/- 3 mmHg, N = 6) in the subcutis. In the skin flap the drop of PscO2 was slower, and after 30 min of arterial occlusion the mean value was 29 mmHg (SEM = +/- 9 mmHg, N = 6). This study has shown that tissue oxygen tension measurement can be used as a sensitive indicator of acute impairment of the supplying vessels in island flaps. The method seems to have potential for monitoring free tissue transfers. A comparable decrease in PscO2 was found for arterial and venous impairment.

  6. Protein Supplementation Does Not Further Increase Latissimus Dorsi Muscle Fiber Hypertrophy after Eight Weeks of Resistance Training in Novice Subjects, but Partially Counteracts the Fast-to-Slow Muscle Fiber Transition.

    PubMed

    Paoli, Antonio; Pacelli, Quirico F; Cancellara, Pasqua; Toniolo, Luana; Moro, Tatiana; Canato, Marta; Miotti, Danilo; Neri, Marco; Morra, Aldo; Quadrelli, Marco; Reggiani, Carlo

    2016-06-01

    The response to resistance training and protein supplementation in the latissimus dorsi muscle (LDM) has never been investigated. We investigated the effects of resistance training (RT) and protein supplementation on muscle mass, strength, and fiber characteristics of the LDM. Eighteen healthy young subjects were randomly assigned to a progressive eight-week RT program with a normal protein diet (NP) or high protein diet (HP) (NP 0.85 vs. HP 1.8 g of protein·kg(-1)·day(-1)). One repetition maximum tests, magnetic resonance imaging for cross-sectional muscle area (CSA), body composition, and single muscle fibers mechanical and phenotype characteristics were measured. RT induced a significant gain in strength (+17%, p < 0.0001), whole muscle CSA (p = 0.024), and single muscle fibers CSA (p < 0.05) of LDM in all subjects. Fiber isometric force increased in proportion to CSA (+22%, p < 0.005) and thus no change in specific tension occurred. A significant transition from 2X to 2A myosin expression was induced by training. The protein supplementation showed no significant effects on all measured outcomes except for a smaller reduction of 2X myosin expression. Our results suggest that in LDM protein supplementation does not further enhance RT-induced muscle fiber hypertrophy nor influence mechanic muscle fiber characteristics but partially counteracts the fast-to-slow fiber shift.

  7. Protein Supplementation Does Not Further Increase Latissimus Dorsi Muscle Fiber Hypertrophy after Eight Weeks of Resistance Training in Novice Subjects, but Partially Counteracts the Fast-to-Slow Muscle Fiber Transition

    PubMed Central

    Paoli, Antonio; Pacelli, Quirico F.; Cancellara, Pasqua; Toniolo, Luana; Moro, Tatiana; Canato, Marta; Miotti, Danilo; Neri, Marco; Morra, Aldo; Quadrelli, Marco; Reggiani, Carlo

    2016-01-01

    The response to resistance training and protein supplementation in the latissimus dorsi muscle (LDM) has never been investigated. We investigated the effects of resistance training (RT) and protein supplementation on muscle mass, strength, and fiber characteristics of the LDM. Eighteen healthy young subjects were randomly assigned to a progressive eight-week RT program with a normal protein diet (NP) or high protein diet (HP) (NP 0.85 vs. HP 1.8 g of protein·kg−1·day−1). One repetition maximum tests, magnetic resonance imaging for cross-sectional muscle area (CSA), body composition, and single muscle fibers mechanical and phenotype characteristics were measured. RT induced a significant gain in strength (+17%, p < 0.0001), whole muscle CSA (p = 0.024), and single muscle fibers CSA (p < 0.05) of LDM in all subjects. Fiber isometric force increased in proportion to CSA (+22%, p < 0.005) and thus no change in specific tension occurred. A significant transition from 2X to 2A myosin expression was induced by training. The protein supplementation showed no significant effects on all measured outcomes except for a smaller reduction of 2X myosin expression. Our results suggest that in LDM protein supplementation does not further enhance RT-induced muscle fiber hypertrophy nor influence mechanic muscle fiber characteristics but partially counteracts the fast-to-slow fiber shift. PMID:27258300

  8. [Oncologic, functional, and aesthetics results; evaluation of the quality of life after latissimus dorsi flap breast reconstruction. About a retrospective series of 450 patients].

    PubMed

    Dejode, M; Bordes, V; Jaffré, I; Classe, J-M; Dravet, F

    2011-06-01

    Retrospective assesssment from 1998 to 2005 from women who have a breast reconstruction by autologus latissimus flap or by latissimus flap and silicone breast implant for differed breast reconstruction (DBR) or mastectomy and immediate breast reconstruction (MIBR). Analysis of oncologic results on 450 patients. Analysis of aesthetic, functional results and of quality of life by an anonymous questionnaire in the non progressive patients (407): 263 appraisable answers (13 DBR, 127 MIBR). Middle age: 49.8 years. Forty-three patients (9.5%) had a relapse of their disease, 33 patients died (7.2%). The relapse of the disease was done in the form of metastasis alone: 29 (67.4%), metastasis and local recurrence: three (7%), local recurrence only: four (9.3%), not specified: seven (16.3%). The average time between the breast reconstruction and the relapse was 18.25±15.4 months. The overall assessment is of 7.68/10. There is no statistical difference between immediate reconstruction and delayed reconstruction. A total of 11.2% patients considered it to be bad (<5/10). The symmetry between the two breasts in time is of 6.6/10 and 19.9% patients considered it to be bad (<5/10). The scar ransom, considered to be most important, is mostly in the back (4.1/10) then on the controlateral breast and then the breast reconstruction. This ransom is not easily acceptable in 15 to 20% of the patients. The discomfort and the pain prevail above all in the back (3.56 and 2.59/10). Weaker symptoms in the event of immediate reconstruction than delayed reconstruction. We noted that 77.2% had kinesitherapy after surgery and 18.9% continues to have kinesitherapy, long time after surgery, mainly for massages of the back. The handicap is considered to be overall low 2.5/10 but 10% of the patients keep a feeling of important handicap (>7.5/10). Seventy-one of the patients are serene. The discomfort to wear a bathing suit or to look at bare-chested is low (2.59 and 2.44/10). However 8.9% are in a

  9. Single-stage maxillary and nasal floor reconstruction with the double-paddle rectus abdominis musculocutaneous free flap.

    PubMed

    Herman, Charles K; Benacquista, Teresa; Brindzei, Nelya; Berdichevsky, Max; Baum, Thomas; Strauch, Berish

    2007-04-01

    Palatal integrity is essential for useful speech, deglutition, good oral hygiene, and prevention of nasal regurgitation. Maxillary defects after tumor extirpation, therefore, can have serious functional and cosmetic implications. Given the often disappointing results obtained with local and regional pedicled flaps for maxillary reconstruction, a variety of microvascular free flaps have been utilized in recent years, including the rectus abdominis, fibular, radial forearm, and latissimus dorsi flaps. Experience with these techniques has been documented in a limited number of case reports. We describe our single-stage approach to maxillary and nasal floor reconstruction with the double skin-paddle rectus abdominis musculocutaneous free flap. A series of five patients is presented; six of these immediate free flap reconstructions were performed for defects resulting from tumor resection. A vertical rectus abdominis musculocutaneous free flap was used in all cases, designing two separate skin paddles to accommodate the measured maxillary and nasal floor deficiencies. Anastomoses of the deep inferior epigastric artery and vena comitans were performed end-to-end to the facial artery and vein, respectively. In addition, orbital floor reconstruction with calvarial bone grafts or titanium mesh was performed in all five patients. Separation of the oral and nasal cavities was maintained postoperatively. No intraoperative complications, perioperative mortalities, flap losses, instances of skin paddle necrosis, hematomas, or oronasal fistulae were observed. One patient required bedside drainage of a surgical site abscess that resolved without adverse sequelae. Over the past 4 years, the double skin-paddle rectus abdominis musculocutaneous free flap has provided reliable results at our institution for single-stage reconstruction of maxillary and nasal floor defects. This reconstructive technique should be considered a viable method that can alleviate the functional and cosmetic

  10. Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions.

    PubMed

    Watanabe, Yorikatsu; Akizuki, Tanetaka; Ozawa, Tsuyoshi; Yoshimura, Kei; Agawa, Kaori; Ota, Tomoyuki

    2009-12-01

    One-stage microneurovascular free muscle transfer is a common surgical procedure for re-animation of established facial paralysis. However, innervation of the transferred muscle by the contralateral facial nerve prevents smile and other facial expressions on one side, and reinnervation requires about 7 months. To overcome these drawbacks, we report a dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer. Three patients were treated with the dual innervation method, which is based on the one-stage method with some modifications: the soft tissue present over the ipsilateral masseter muscle and the hilum where the thoracodorsal nerve proceeds into the muscle segment is removed; the muscle is harvested to locate the hilum in the cranial one-third of the segment; and the muscle is transferred to the malar pocket of the paralysed face such that the hilum contacts the masseter muscle. On average, muscle movement was recognised on voluntary biting at 3.4 months and on spontaneous smiling at 5.9 months after surgery. A dual innervation sign was recorded on electromyographs 6.4 months after surgery. The patients developed a spontaneous symmetrical smile and facial expressions on one side with minimum synkinesis after postoperative mirror rehabilitation. The advantages of the dual innervation method include faster reinnervation of the transferred muscle compared to one-stage options; achievement of spontaneous smile and voluntary smile on each side; augmentation of neural signals to the muscle for more symmetrical smiling; minimum synkinesis of the transferred muscle on biting for eyelid closure and emotional facial re-animation through a learning program to enhance cerebral cortical reorganisation.

  11. Isolated musculocutaneous neuropathy in an adolescent baseball pitcher.

    PubMed

    Henry, Dorlyne; Bonthius, Daniel J

    2011-12-01

    Injury of the musculocutaneous nerve very rarely occurs in the absence of concomitant injury to other components of the brachial plexus. Until now, the few cases of isolated musculocutaneous nerve palsies have been reported only in adults. We report a case of isolated musculocutaneous neuropathy in a uniquely talented adolescent baseball pitcher. The biomechanics underlying this adolescent's ability to throw with high velocity likely contributed to the musculocutaneous nerve injury in this case.

  12. Vertical trapezius musculocutaneous flap: a retrospective study.

    PubMed

    Papadopoulos, Othon N; Chrisostomidis, Chrisostomos I; Georgiou, Panagis N; Frangoulis, Marios B; Zapantis-Fragos, Menelaos K; Champsas, Grigorios G

    2005-01-01

    From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.

  13. Unusual variation in musculocutaneous nerves in Nepalese.

    PubMed

    Bhattarai, C; Poudel, P P

    2009-01-01

    Variations in origin, course, branching pattern, termination and connections of the musculocutaneous nerve in the arm are not as uncommon as was once thought. Variational study of nerve in Nepalese is very less and can be of surgical-clinical importance. This opinion led us to performing this study. The aim of this study was to a study in Nepalese which could be important for clinical investigation and the surgical treatment of peripheral nerve injury. This study was carried out in Manipal College of medical sciences (MCOMS). Dissection of formalised 16 cadavers (n=32 upper limbs) were carried out using normal dissection kit with the help of standard dissection manual in two and half years. The study revealed the variation in course, branching pattern and termination of musculocutaneous nerve in 6.25% of cases unilaterally on the right side. No statistically significant differences by gender and side were observed. This present study provides the evidence of variation of musculocutaneous nerve in Nepalese. The knowledge of the anatomical variations of the peripheral nerve system can help explain an incomprehensible clinical sign.

  14. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    SciTech Connect

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-08-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

  15. [PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

    PubMed

    Pavlov, V N; Bakirov, A A; Kabirov, I R; Izmajlov, A A; Kutlijarov, L M; Safiullin, R L; Urmancev, M F; Sultanov, I M; Abdrahimov, R V

    2015-01-01

    Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.

  16. Rare anatomical variation of the musculocutaneous nerve - case report.

    PubMed

    Nascimento, Sergio Ricardo Rios; Ruiz, Cristiane Regina; Pereira, Eduardo; Andrades, Lilian; de Souza, Cristiano Cirqueira

    2016-01-01

    The clinical and surgical importance of anatomical knowledge of the musculocutaneous nerve and its variations is due to the fact that one of the complications in many upper-limb surgical procedures involves injury to this nerve. During routine dissection of the right upper limb of a male cadaver, we observed an anatomical variation of this nerve. The musculocutaneous nerve originated in the lateral cord and continued laterally, passing under the coracobrachialis muscle and then continuing until its first branch to the biceps brachialis muscle. Just after this, it supplied another two branches, i.e. the lateral cutaneous nerve of the forearm and a branch to the brachialis muscle, and then it joined the median nerve. The median nerve followed the arm medially to the region of the cubital fossa and then gave rise to the anterior intermediate nerve of the forearm. The union between the musculocutaneous nerve and the median nerve occurred approximately at the midpoint of the arm and the median nerve. Given that either our example is not covered by the classifications found in the literature or that it fits into more than one variation proposed, without us finding something truly similar, we consider this variation to be rare.

  17. Experimental comparison of bone revascularization by musculocutaneous and cutaneous flaps

    SciTech Connect

    Fisher, J.; Wood, M.B.

    1987-01-01

    Revascularization, one of the major components of bone healing, was examined in an experimental model. The radioactive microsphere technique demonstrated that after 4 weeks beneath a musculocutaneous flap, isolated bone segments had significant blood flow, whereas bone beneath a cutaneous flap did not. The muscle flap bone had a blood flow approximately half that of normal control bone. The muscle of the musculocutaneous flap had a blood flow three times that of the skin of the cutaneous flap. The bipedicle cutaneous flap used was designed to have a healthy blood supply, and at 4 weeks it had a blood flow twice that of control skin. Despite this, there was essentially no demonstrable blood flow in the cutaneous flap bone segments at 4 weeks. Only 3 of 17 bone segments underneath cutaneous flaps showed medullary vascularization, whereas 10 of 11 muscle flap bones did. All bone segments underneath muscle flaps showed osteoblasts and osteoclasts at 4 weeks; neither were seen in the cutaneous bone segments. The process of revascularization occurred through an intact cortex and penetrated into the cancellous bone. Because the bone segments were surrounded by an impervious barrier except for one cortical surface, the cellular activity seen is attributed to revascularization by the overlying flap. In this model, a muscle flap was superior to a cutaneous flap in revascularizing isolated bone segments at 4 weeks. This was documented by blood flow measured by the radioactive microsphere technique and by bone histology.

  18. Muscle-derived Decellularised Extracellular Matrix Improves Functional Recovery in a Rat Latissimus Dorsi Muscle Defect Model

    DTIC Science & Technology

    2013-12-01

    presented as mean standard error of the mean (SEM). Results Model development Po increased over 4 weeks in both control and defect groups due to growth ...extremities10,21,28 and abdominal muscles.16,24 Our focus was on the muscles of the craniofacial maxillary re- gion. We therefore developed an animal... maxillary injuries; Muscle function; Skeletal muscle; Volumetric muscle loss Summary Purpose: Craniofacial maxillary injuries represent nearly 30% of all

  19. Microsurgical anatomy of branches of musculocutaneous nerve: clinical relevance for spastic elbow surgery.

    PubMed

    Thieffry, C; Chenin, L; Foulon, P; Havet, E; Peltier, J

    2017-07-01

    The neurotomy of musculocutaneous nerve is a treatment for patients who suffer from spastic elbow flexion when medical and reeducative treatments have failed. It consists in sectioning motor branches of musculocutaneous nerve which are destined to the biceps brachii and brachialis muscles, both being the main elbow flexor muscles. The aim of this study was to analyse the distance, where each motor branch arises from the musculocutaneous nerve to both biceps brachii and brachialis muscles, to establish precisely the localisation and length of the necessary incision to reach its branches for surgery. Eighteen musculocutaneous nerves from ten cadavers were dissected. None of them reported with a previous pathology. The cadavers were laid on the back with 30-35° of abduction, a complete extension, and supination of the upper limb. The localization of motor branches was to be found in the middle third of the upper arm, with an average from the base of the humeral major tubercle of 11.46, 12.40, and 12.87 cm for the biceps brachii and 16.36, 19.10, and 16.88 cm for the brachialis muscle. The incision needed to reach the motor branches of the musculocutaneous nerve should be localised between 10 and 20 cm from the major humeral tubercle and may be shorter than usual.

  20. Elastofibroma dorsi. Our experience with 11 lesions.

    PubMed

    Novati, Federico Cesare; Franchi, Alberto; Papa, Giovanni; Arnež, Zoran Marij

    2014-12-29

    Elastofibroma is a rare benign lesion that typically arises on the posterior chest wall beneath the scapula. The etiopathogenesis is still unclear and the knowledge about its diagnosis and management mainly comes from small case series. We collected all the data related to 11 Elastofibroma Dorsi treated at our institution between January 2003 and July 2014. The definitive diagnosis was made by histological examination of the mass. We analyzed the characteristic of the patients, (i.e. age, sex, dominant hand, and occupation), the presenting symptoms and signs, the preoperative investigations, surgical management and complications comparing our findings with the current medical literature on the subject. We found that preoperative investigations are of limited value and when clinical presentation is typical the diagnosis could be made presumptively. Surgery should be performed under general anaesthesia since local anaesthetic infiltration and sedation are often inadequate to reduce intraoperative discomfort.

  1. Elastofibroma dorsi: review of 4 cases.

    PubMed

    Cavallasca, Javier A; Sohn, Debora I; Borgia, Ariel R; Maliandi, María Del Rosario; Musuruana, Jorge L

    2012-01-01

    Elastofibroma dorsi is a benign, uncommon fibroelastic tissue condition, more common in women after the fifth decade of life. It is usually located in the subscapular region, and can sometimes be bilateral. We present 4 patients, between 53 and 73 years of age, with this disease. It is often an asymptomatic lesion that can manifest, even at its apex, with mild pain when moving the scapula. All our patients had pain.The diagnosis is based on clinical findings and imaging studies, especially ultrasound, computed tomography, and nuclear magnetic resonance. The biopsy is reserved for patients who have no characteristic signs on imaging. In our series, surgical excision was necessary in one of the patients, and in the others, clinical and imaging studies allowed us to arrive at a definitive diagnosis.

  2. Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy.

    PubMed

    Blaauw, Gerhard; Slooff, Albert C J

    2003-08-01

    To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

  3. The Transverse Musculocutaneous Gracilis Free Flap: Virtual Animation-Assisted Dissection and Application in Breast Reconstruction.

    PubMed

    Gabert, Pierre-Elliott; Bodin, Frederic; Aljudaibi, Nawaf; Duquennoy-Martinot, Veronique; Guerreschi, Pierre

    2016-05-01

    The transverse musculocutaneous gracilis free flap is a valuable choice for autologous tissue, unilateral or bilateral breast reconstruction. This procedure is an excellent and customized option for immediate or delayed breast reconstruction in patients with small to moderate size breasts. Few descriptions of flap dissection and breast mound shaping are available. In this first educational video, the authors report the original dissection of the transverse musculocutaneous gracilis free flap used for breast reconstruction. Virtual animations insist on surgical key points and relevant details of the harvesting of the flap.

  4. Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report

    PubMed Central

    Godoy-Santos, Alexandre L.; Amodio, Daniel T.; Pires, André; Lima, Ana L. M.; Wei, Teng H.; de Cesar-Netto, Cesar; Armstrong, David G.

    2017-01-01

    ABSTRACT The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team. PMID:28326158

  5. Clinical Applications of the Transverse Musculocutaneous Gracilis Flap for Secondary Breast Reconstruction after Simple Mastectomy.

    PubMed

    Wechselberger, Gottfried; Traintinger, Heike; Larcher, Lorenz; Russe, Elisabeth; Edelbauer, Monika; Ensat, Florian

    2016-01-01

    In secondary autologous breast reconstruction, the current standard is a flap derived from the lower abdomen or the back. If these donor sites are not available because of lack of tissue, prior operations, or simply the patient's desire to avoid these donor sites, the authors use the transverse musculocutaneous gracilis flap if feasible. The authors retrospectively evaluated only patients where secondary autologous breast reconstruction was performed with a transverse musculocutaneous gracilis flap because of the prior mentioned reasons. Indications, limitations, advantages, and technique are discussed by sharing the authors' experience in 23 patients using 26 transverse musculocutaneous gracilis flaps. No flap loss could be observed in this series. In four patients, minimal lateral skin necrosis could easily be managed by débridement and primary wound closure. In 12 cases, subsequent lipofilling was performed for a better breast shape. On average, patient satisfaction was high. Secondary reconstruction after simple mastectomy using the transverse musculocutaneous gracilis flap requires a little more experience than after skin-sparing mastectomy but, especially combined with later lipofilling, can lead to an optimally shaped breast in selected patients with substantial skin laxity and fat distribution at the inner thigh. Therapeutic, IV.

  6. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

    PubMed Central

    Liu, Ying; Xu, Xun-cheng; Zou, Yi; Li, Su-rong; Zhang, Bin; Wang, Yue

    2015-01-01

    Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘excellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery. PMID:25883637

  7. [Transplantation of free latissimus dorsimyocutaneous flaps for repairing head and neck defect after tumor resection].

    PubMed

    Chen, Jin; Wang, Zhaohui; Tang, Tao; Li, Chunhua; Cai, Yongcong

    2015-12-01

    To explore the value of free latissimus dorsimyocutaneous flap in repairing severe defect of head and neck after resection of tumor. Free latissimus dorsimyocutaneous flap was used to repair defect after resection of tumor in 12 patients (13 sides) with head and neck tumors. Of them 2 cases underwent radical radiotherapy before operation. and 3 cases received adjuvant radiotherapy postoperatively. Aside from one flap with necrosis, other 12 flaps survived after operation including 5 cases with radiotherapy. Free latissimus dorsimyocutaneous flap can afford large tissue, has reliable blood supply, is easy to survive, and resist to radiotherapy, which is fit for repairing severe defect of head and neck.

  8. Reconstruction of sternal cleft and aplasia cutis with a Medpor and a rectus abdominis musculocutaneous flap.

    PubMed

    Shen, Weimin; Cui, Jie; Chen, Jianbin; Zou, Jijun; Ji, Yi; Chen, Haini

    2012-01-01

    Superior sternal cleft is a rare congenital malformation that may represent a challenge for plastic surgeons. We describe a 1-day-old neonate. She was noted to have superior sternal cleft associated with aplasia cutis ahead the sternum. Three days after birth, she successfully underwent primary repair using a Medpor and a rectus abdominis musculocutaneous flap. This is a novel concept of successfully constructing the sternal cleft associated with aplasia cutis.

  9. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap.

    PubMed

    Han, Dong-Seok; Jang, Hoon; Youn, Chang-Shik; Yuk, Seung-Mo

    2015-06-19

    Until recently, no single, universally accepted surgical method has existed for all types of concealed penis repairs. We describe a new surgical technique for repairing concealed penis by using an advanced musculocutaneous scrotal flap. From January 2010 to June 2014, we evaluated 12 patients (12-40 years old) with concealed penises who were surgically treated with an advanced musculocutaneous scrotal flap technique after degloving through a ventral approach. All the patients were scheduled for regular follow-up at 6, 12, and 24 weeks postoperatively. The satisfaction grade for penile size, morphology, and voiding status were evaluated using a questionnaire preoperatively and at all of the follow-ups. Information regarding complications was obtained during the postoperative hospital stay and at all follow-ups. The patients' satisfaction grades, which included the penile size, morphology, and voiding status, improved postoperatively compared to those preoperatively. All patients had penile lymphedema postoperatively; however, this disappeared within 6 weeks. There were no complications such as skin necrosis and contracture, voiding difficulty, or erectile dysfunction. Our advanced musculocutaneous scrotal flap technique for concealed penis repair is technically easy and safe. In addition, it provides a good cosmetic appearance, functional outcomes and excellent postoperative satisfaction grades. Lastly, it seems applicable in any type of concealed penis, including cases in which the ventral skin defect is difficult to cover.

  10. Musculocutaneous nerve injury after simulated freefall in a vertical wind-tunnel: a case report.

    PubMed

    Mautner, Kenneth; Keel, John C

    2007-03-01

    We report a case of a skydiver with isolated musculocutaneous nerve injury, which occurred after prolonged positioning of the arm during simulated freefall in a vertical wind-tunnel. Musculocutaneous nerve injury is rare, and the mechanism of isolated injury to this nerve is not entirely understood. Isolated peripheral nerve injuries such as this easily mimic other injuries and can be difficult to diagnose. The skydiver complained of right arm weakness and numbness that began after training in a vertical wind-tunnel. Exam revealed weakness in right elbow flexion and forearm supination, and diminished sensation in the right lateral forearm. Electrodiagnostic testing revealed a decreased amplitude in the right lateral antebrachial cutaneous nerve sensory nerve action potential, and fibrillations and positive sharp waves in the biceps and brachialis muscles. By 5 months, the subject reported complete sensory and motor recovery. Physical and electrodiagnostic findings corresponded to the distribution of the musculocutaneous nerve. The mechanism of injury was likely the prolonged abducted, extended, and externally rotated position of the shoulder during simulated freefall. Although isolated nerve injuries are uncommon, unusual activities and physiologic demands of athletes can result in such injuries. It is important to be aware of peripheral nerve injuries to facilitate proper diagnosis and management.

  11. Radial plus musculocutaneous nerve stimulation for axillary block is inferior to triple nerve stimulation with 2% mepivacaine.

    PubMed

    Rodríguez, Jaime; Taboada, Manuel; Oliveira, Juan; Ulloa, Beatriz; Bascuas, Begoña; Alvarez, Julián

    2008-06-01

    To compare the extent of sensory and motor block with two different nerve stimulation techniques in axillary blocks. Prospective, randomized, investigator-blinded study. Ambulatory surgery unit of a university hospital. 60 ASA physical status I, II, and III patients undergoing surgery at or below the elbow. Patients receiving axillary block were randomized into two nerve stimulation groups with either radial plus musculocutaneous or triple nerve stimulation (radial, median, and musculocutaneous nerves). Thirty milliliters of plain 2% mepivacaine was given to all patients either in a single or fractionated dosing for radial or for radial and median nerves, according to group assignment. Five milliliters of plain 1% mepivacaine for the musculocutaneous nerve was given to all patients. Blocks were assessed at 10, 20, and 30 minutes. Rates of supplementation given as a result of insufficient surgical anesthesia were also noted. Statistically significantly higher rates of anesthesia at the cutaneous distributions of median and medial cutaneous of the arm nerves with multiple nerve stimulation at 30 minutes were found as compared with radial plus musculocutaneous nerve stimulation. The rate of supplementation was lower with multiple nerve stimulation. Radial plus musculocutaneous nerve stimulation showed lower efficacy of axillary block than did triple nerve stimulation when using 2% mepivacaine.

  12. Grafting the C5 root to the musculocutaneous nerve partially restores hand sensation in complete palsies of the brachial plexus.

    PubMed

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2012-08-01

    In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves. To investigate sensory recovery in the hand and forearm after C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury. Eleven patients who had recovered elbow flexion after musculocutaneous nerve grafting from a preserved C5 root and who had been followed for a minimum of 3 years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static 2-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water. All grafted patients recovered sensation in a variable territory extending from just over the thenar eminence to the entire lateral forearm and hand. Seven patients were capable of perceiving 2-0 monofilament pressure on the thenar eminence, palm, and dorsoradial aspect of the hand. All could differentiate warm and cold water. None recovered 2-point discrimination. None of the patients in the control group recovered any kind of sensation in the affected limb. Grafting the musculocutaneous nerve can restore nociceptive sensation on the radial side of the hand.

  13. Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin’s ulcer: a short report focused on preoperative imaging

    PubMed Central

    Thomassen, Anders; Jensen, Jesper Poul Naested; Soerensen, Jens Ahm

    2014-01-01

    We present a case of a 56-year-old man with a giant carcinoma in the abdominal wall. Based on positron emission tomography/computed tomography (PET/CT) scan there were FDG-avid lymph nodes in the ipsilateral axillary and groin, suspicious for metastases. At contrast-enhanced CT the parietal peritoneum seemed free of tumor invasion, which was essential to radical surgery planning. The tumor was completely removed with clear margins of resection and no metastasis in the resected lymph nodes. The PET/CT scan was repeated after 4 months, showing no signs of recurrence. PMID:24778800

  14. Reconstruction of full-thickness chest wall defects using rectus abdominis musculocutaneous flap: A report of fifteen cases

    SciTech Connect

    Miyamoto, Y.; Hattori, T.; Niimoto, M.; Toge, T. )

    1986-02-01

    In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.

  15. The relationship of the musculocutaneous nerve to the brachial plexus evaluated by MRI.

    PubMed

    Kjelstrup, Trygve; Sauter, Axel R; Hol, Per K

    2017-02-01

    Axillary plexus blocks (AXB) are widely used for upper limb operations. It is recommend that AXB should be performed using a multiple injection technique. Information about the course and position of the musculocutaneous nerve (MCN) is of relevance for AXB performance. The objective of this study was to examine the position of the MCN and its relationship to the axillary sheath using MRI. 54 patients underwent an AXB with 40 ml of local anaesthetic before MRI examination. The course of the MCN and the position where it left the axillary sheath and perforated the coracobrachial muscle (MCN exit point), in relation to the axillary artery and the block needle insertion point in the axillary fold, were recorded. The MCN was seen clearly in 23, partly in 26, and not identified in five patients at the MCN exit point. The mean distance from the insertion point of the block needle in the axillary fold to the MCN exit point was 36.8 mm (SD = 18.9, range: 0-90.5). In 37 patients the MCN exit point was positioned inside the Q1 quadrant (lateral anterior to the axillary artery) and in 11 patients inside the Q2 quadrant (medial anterior to the axillary artery). There is a wide variability as to where the musculocutaneous nerve (MCN) leaves the axillary sheath. Therefore multiple injection techniques, or the use of a proximally directed catheter, should be appropriate to block the MCN.

  16. Long-term survival after chest-wall reconstruction with musculocutaneous flaps

    SciTech Connect

    Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. )

    1990-10-01

    Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures.

  17. The Transverse Musculocutaneous Gracilis Flap for Breast Reconstruction Educational Illustration Series

    NASA Astrophysics Data System (ADS)

    Steenberg, Ryan

    Advancements in medicine have allowed surgeons a menu of options in post-mastectomy breast reconstruction. A conundrum exists, however, in flap selection when faced with varying patient body types. In the case of the athletic patient who does not have the appropriate amount of donor site tissue to warrant a Transverse Rectus Abdominus Musculocutaneuos Flap (TRAM) the Transverse Musculocutaneous Gracilis Flap (TMG) is an appropriate alternative due to its functional and aesthetic benefits. An intricate and timely process, the TMG procedure can be difficult to understand for the layperson. Therefore, a need for a condensed and standardized description exists. By breaking the process down and illustrating the procedure one can effectively deliver the information for use across all realms of publication and education.

  18. Soft-tissue coverage of olecranon with musculocutaneous flexor carpi ulnaris flap.

    PubMed

    Andre, A; Bonnevialle, N; Grolleau, J-L; Mansat, P

    2014-12-01

    Coverage of the olecranon area is always challenging in traumatology. Because of the superficial situation of the bone, the absence of muscle, the thinness of the skin and the subcutaneous tissue locally, skin defects are not uncommon and can lead to exposure of hardware or prostheses. We report an original surgical technique using a musculocutaneous flap from the flexor carpi ulnaris (FCU) with a proximal pedicle to cover the olecranon area, detailing its limits and indications. The FCU flap has become our first-choice procedure to cover olecranon skin defects because of its low morbidity, its reliability, and its straightforward procedure, obviating the need for any microsurgery technique. Furthermore, it allows moving the elbow, immediately decreasing the risk of elbow stiffness. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Definition of the gracilis musculocutaneous flap for distant transfer in cats.

    PubMed

    Gregory, C R; Gourley, I M; Snyder, J R; Ilkiw, J

    1992-01-01

    Dissection, injection, and surgical studies in feline cadavers and in anesthetized cats were conducted to determine the feasibility of using the gracilis muscle as the basis for a free musculocutaneous flap. The vascular pedicle of the flap consisted of the femoral artery and vein. Mean length (1.6 +/- 0.2 cm) of the vascular pedicle and mean artery (1.33 +/- 0.19 mm) and vein (2.55 +/- 0.38 mm) diameters were satisfactory for microvascular transfer. Fluorometry revealed overlying cutaneous perfusion in the flaps on the basis of their muscle vascular pedicles. To ensure survival of the flap, the muscular branches of the femoral artery and vein supplying the gracilis muscle had to be carefully preserved during surgical elevation of the flap.

  20. A new flap alternative for trochanteric pressure sore coverage: distal gluteus maximus musculocutaneous advancement flap.

    PubMed

    Nisanci, Mustafa; Sahin, Ismail; Eski, Muhitdin; Alhan, Dogan

    2015-02-01

    Management of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap.

  1. A novel classification of musculocutaneous nerve variations: The relationship between the communicating branch and transposed innervation of the brachial flexors to the median nerve.

    PubMed

    Hayashi, Mari; Shionoya, Kento; Hayashi, Shogo; Hatayama, Naoyuki; Kawata, Shinichi; Qu, Ning; Hirai, Shuichi; Miyaso, Hidenobu; Itoh, Masahiro

    2017-01-01

    The musculocutaneous nerve innervates the brachial flexors; i.e., the coracobrachialis, biceps brachii, and brachialis. The musculocutaneous and median nerve sometimes share a communicating branch and also muscular branches to brachial flexors are sometimes transposed to median nerve. Because these variations constitute a potentially important clinical and surgical issue, we evaluated 130 upper limbs of 65 cadavers and 184 cases of musculocutaneous and median nerve variations in the literature and devised a novel system of classification that covers each pattern of variation. Our proposed classification was applicable in all of our cases and those previously reported. In addition, transposed innervation of the brachial flexors from the musculocutaneous nerve to the communicating branches was observed in one limb in our case series. In this case and all previously reported cases of transposed innervation of the brachial flexors, communicating branches between the musculocutaneous and median nerve were found and no brachial flexor branch arose from the musculocutaneous nerve distal to the communicating branches. Consequently, we established that, as per our novel classification, all patterns of communicating branches could be classified into five types and the patterns of transposed innervation of the brachial flexors into three types. Copyright © 2016 Elsevier GmbH. All rights reserved.

  2. A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

    PubMed Central

    Aliu, Oluseyi; Samra, Saleh; Lewis, Eric

    2007-01-01

    A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient’s treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113

  3. Pathologic studies of acute rejection of mismatched feline musculocutaneous flaps. Effect of cyclosporine and prednisolone.

    PubMed

    Gregory, C R; Gourley, I M; Ferreira, H; Moore, P F; Imondi, K A; Patz, J D; Gregory, T A; Pedersen, N C

    1991-06-01

    The gracilis musculocutaneous flap was developed as an allograft model to study acute rejection and immunosuppression in the cat. Twelve adult cats received a MLC incompatible flap. Six of the cats received cyclosporine oral solution and prednisolone (0.5 mg/kg/24 hr) for 100 days and six cats were not treated. Trough whole-blood levels of cyclosporine in the treatment group were maintained at approximately 750 ng/ml for 70 days, then 500 ng/ml for the remaining 30 days. Three flaps failed due to technical problems; 5 flaps were studied in the treatment group and 4 in the untreated group. All 5 flaps in the treatment group survived the 100 day treatment period and were rejected 30 +/- 26 days following cessation of treatment. Prior to discontinuation of treatment, with the exception of one cat, inflammatory changes associated with rejection were not observed in biopsy specimen. The flaps in the untreated group survived 13 +/- 1.5 days. Histopathologic examination of the flaps revealed little difference in the appearance of acute rejection and rejection after cessation of therapy. The most prominent lesion was a vasculitis with extensive perivascular lymphohistocytic inflammation. The lymphoid infiltrates consisted predominantly of T cells of both major classes (CD4 and CD8). Full-thickness epidermal necrosis and subsequent bacterial invasion followed vascular compromise.

  4. Reconstruction of the Head and Neck Region Using Lower Trapezius Musculocutaneous Flaps

    PubMed Central

    Yoon, Soo Kwang; Song, Seung Han; Kang, Nakheon; Yoon, Yeo-Hoon; Koo, Bon Seok

    2012-01-01

    Background Recent literature has indicated that free flaps are currently considered the preferred choice for head and neck reconstruction. However, head and neck cancer patients are frequently treated with chemoradiotherapy, which is often associated with a poor general and local condition, and thus, such patients are ineligible for free flap reconstruction. Therefore, other reconstruction modalities should be considered. Methods We used lower trapezius musculocutaneous (LTMC) flap based on the dorsal scapular artery to reconstruct head and neck defects that arose from head and neck cancer in 8 patients. All of the patients had undergone preoperative chemoradiotherapy. Results There were no complications except one case of partial flap necrosis; it was treated with secondary intention. Healing in the remaining patients was uneventful without hematoma, seroma, or infection. The donor sites were closed primarily. Conclusions The LTMC flap is the preferred flap for a simple, reliable, large flap with a wide arc of rotation and minor donor-site morbidity. The authors recommend this versatile island flap as an alternative to microvascular free tissue transfer for the reconstruction of defects in the head and neck region, for patients that have undergone preoperative chemoradiotherapy. PMID:23233888

  5. Transverse musculocutaneous gracilis flap for treatment of capsular contracture in tertiary breast reconstruction.

    PubMed

    Pülzl, Petra; Huemer, Georg M; Schoeller, Thomas

    2015-02-01

    Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears. We performed 52 deepithelialized free transverse musculocutaneous gracilis (TMG) flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG flap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry. The advantages of the TMG flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation.

  6. Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury.

    PubMed

    Maldonado, Andrés A; Kircher, Michelle F; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2016-09-01

    After complete five-level root brachial plexus injury, free functional muscle transfer and intercostal nerve transfer to the musculocutaneous nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus intercostal nerve-to-musculocutaneous nerve transfers with respect to strength. Sixty-two patients who underwent free functional muscle transfer reconstruction or intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the intercostal nerve-to-musculocutaneous nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of intercostal nerves used for the musculocutaneous nerve transfer did not correlate with better elbow flexion grade. Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. Therapeutic, III.

  7. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications.

    PubMed

    Bodin, Frédéric; Dissaux, Caroline; Dupret-Bories, Agnes; Schohn, Thomas; Fiquet, Caroline; Bruant-Rodier, Catherine

    2016-01-01

    The transverse musculocutaneous gracilis (TMG) flap has become a common solution for breast reconstruction. However, the safe skin paddle limits are not yet understood. In this study, we attempted to address this issue based on our experiences with inferior and posterior skin paddle extension. Forty-four breast reconstructions with TMG flaps performed between November 2010 and January 2014 were analyzed retrospectively. For the first 20 cases, the flap skin paddle was extended 3 cm posteriorly to the middle thigh (group 1). For the next 20 flaps (group 2), the posterior tip was limited to this line, whereas more fat was recruited inferiorly. In the four cases of group 3, the skin flap was extended posteriorly with a second vascular pedicle from the profunda artery perforator (PAP) flap. The weights and the dimensions of the flaps, operating durations, and postoperative complications of the entire series were analyzed. Groups 1 and 2 were statistically compared. Flap complications were statistically more frequent in group 1 compared with group 2 (45 vs. 0%, P = 0.0012); 40% posterior flap tip necrosis was observed in group 1. Conversely, donor site complications were statistically more frequent in group 2 than in group 1 (40 vs. 5%, P = 0.019) with 35% inner thigh dehiscence. In the TMG with extended PAP flap group, the operating duration was 77 min longer compared with the rest of the series with no donor site complications. In one case, limited necrosis occurred at the anterior skin tip. Harvesting the posterior portion of the TMG up to the middle of the posterior thigh may lead to partial flap necrosis. Extending subcutaneous fat removal under the inferior skin incision may increase the risk of donor site complications. Adding a second vascular pedicle from the PAP flap may improve posterior TMG tip perfusion at the expense of a longer operation. © 2015 Wiley Periodicals, Inc.

  8. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications

    PubMed Central

    Ballesteros, Luis Ernesto; Forero, Pedro Luis; Buitrago, Edna Rocío

    2014-01-01

    Objective To determine the frequency and features of communication between the musculocutaneous nerve (MCN) and median nerve (MN) in a sample of the Colombian population, and assess its clinical implication. Methods The arms of 53 cadaver specimens that had been subjected to necropsy at the National Institute of Forensic Medicine, in Bucaramanga, Colombia, were studied. The structures of the anterior compartment of the arm were dissected and characterized regarding the presence of communication between the MCN and MN. Results A communicating branch was found in 21/106 upper limbs (19.8%), occurring bilaterally in 10 (47.6%) and unilaterally in 11 (52.4%), without significant difference regarding the side of occurrence (p = 0.30). In 17% of the cases, there was MCN-MN communication in which the communicating branch was seen leaving the MCN after piercing the coracobrachialis muscle (Type I). In 2.8%, the connection was from the MN to the MCN (Type II). The length of the communicating branch was 57.8 ± 33.4 mm. The distances from the proximal and distal points of this branch to the coracoid process were 138 ± 39.4 mm and 188 ± 48.3 mm, respectively. The communicating branch was located mostly in the middle third of the arm. Conclusions The frequency of MCN-MN communication observed in the present study is in the middle of the range of what was reported in previous studies. MCN-MN connections need to be taken into account in diagnosing and managing peripheral nerve lesions of the upper limbs. PMID:26535190

  9. A giant plexiform schwannoma of the brachial plexus: case report

    PubMed Central

    2011-01-01

    We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed. PMID:22044580

  10. Comparison of outcomes of pressure sore reconstructions among perforator flaps, perforator-based rotation fasciocutaneous flaps, and musculocutaneous flaps.

    PubMed

    Kuo, Pao-Jen; Chew, Khong-Yik; Kuo, Yur-Ren; Lin, Pao-Yuan

    2014-10-01

    Pressure sore reconstruction remains a significant challenge for plastic surgeons due to its high postoperative complication and recurrence rates. Free-style perforator flap, fasciocutaeous flap, and musculocutaneous flap are the most common options in pressure sore reconstructions. Our study compared the postoperative complications among these three flaps at Kaohsiung Chang Gung Memorial Hospital. From 2003 to 2012, 99 patients (54 men and 45 women) with grade III or IV pressure sores received regional flap reconstruction, consisting of three cohorts: group A, 35 free-style perforator-based flaps; group B, 37 gluteal rotation fasciocutaneous flaps; and group C, 27 musculocutaneous or muscle combined with fasciocutaneous flap. Wound complications such as wound infection, dehiscence, seroma formation of the donor site, partial or complete flap loss, and recurrence were reviewed. The mean follow-up period for group A was 24.2 months, 20.8 months in group B, and 19.0 months for group C. The overall complication rate was 22.9%, 32.4%, and 22.2% in groups A, B, and C, respectively. The flap necrosis rate was 11.4%, 13.5%, and 0% in groups A, B, and C, respectively. There was no statistical significance regarding complication rate and flap necrosis rate among different groups. In our study, the differences of complication rates and flap necrosis rate between these groups were not statistically significant. Further investigations should be conducted. © 2014 Wiley Periodicals, Inc.

  11. Enhancement of musculocutaneous nerve reinnervation after vascular endothelial growth factor (VEGF) gene therapy

    PubMed Central

    2012-01-01

    Background Vascular endothelial growth factor (VEGF) is not only a potent angiogenic factor but it also promotes axonal outgrowth and proliferation of Schwann cells. The aim of the present study was to quantitatively assess reinnervation of musculocutaneous nerve (MCN) stumps using motor and primary sensory neurons after plasmid phVEGF transfection and end-to-end (ETE) or end-to-side (ETS) neurorrhaphy. The distal stump of rat transected MCN, was transfected with plasmid phVEGF, plasmid alone or treated with vehiculum and reinnervated following ETE or ETS neurorrhaphy for 2 months. The number of motor and dorsal root ganglia neurons reinnervating the MCN stump was estimated following their retrograde labeling with Fluoro-Ruby and Fluoro-Emerald. Reinnervation of the MCN stumps was assessed based on density, diameter and myelin sheath thickness of regenerated axons, grooming test and the wet weight index of the biceps brachii muscles. Results Immunohistochemical detection under the same conditions revealed increased VEGF in the Schwann cells of the MCN stumps transfected with the plasmid phVEGF, as opposed to control stumps transfected with only the plasmid or treated with vehiculum. The MCN stumps transfected with the plasmid phVEGF were reinnervated by moderately higher numbers of motor and sensory neurons after ETE neurorrhaphy compared with control stumps. However, morphometric quality of myelinated axons, grooming test and the wet weight index were significantly better in the MCN plasmid phVEGF transfected stumps. The ETS neurorrhaphy of the MCN plasmid phVEGF transfected stumps in comparison with control stumps resulted in significant elevation of motor and sensory neurons that reinnervated the MCN. Especially noteworthy was the increased numbers of neurons that sent out collateral sprouts into the MCN stumps. Similarly to ETE neurorrhaphy, phVEGF transfection resulted in significantly higher morphometric quality of myelinated axons, behavioral test and the

  12. Effects of quantitative trait loci on mineral content 1 of bovine longissimus dorsi muscle

    USDA-ARS?s Scientific Manuscript database

    Beef cattle require dietary minerals to maintain their health, production and reproduction. Concentrations of minerals in tissues are at least partially genetically determined. Mapping genomic regions related to the mineral content of the bovine longissimus dorsi muscle may help in the identificatio...

  13. The effect of transcutaneous electrical nerve stimulation on postural sway on fatigued dorsi-plantar flexor.

    PubMed

    Yu, JaeHo; Lee, SoYeon; Kim, HyongJo; Seo, DongKwon; Hong, JiHeon; Lee, DongYeop

    2014-01-01

    The application of transcutaneous electrical nerve stimulation (TENS) enhances muscle weakness and static balance by muscle fatigue. It was said that TENS affects decrease of the postural sway. On the other hand, the applications of TENS to separate dorsi-plantar flexor and the comparison with and without visual input have not been studied. Thus, the aim of this study was to compare the effects of TENS on fatigued dorsi-plantar flexor with and without visual input. 13 healthy adult males and 12 females were recruited and agreed to participate as the subject (mean age 20.5 ± 1.4, total 25) in this study after a preliminary research. This experiment was a single group repeated measurements design in three days. The first day, after exercise-induced fatigue, the standing position was maintained for 30 minutes and then the postural sway was measured on eyes open(EO) and eyes closed(EC). The second, TENS was applied to dorsi flexor in standing position for 30 minutes after conducting exercise-induced fatigue. On the last day, plantar flexor applied by TENS was measured to the postural sway on EO and EC after same exercise-induced fatigue. The visual input was not statistically difference between the groups. However, when compared of dorsi-plantar flexor after applied to TENS without visual input, the postural sway of plantar flexor was lower than the dorsi flexor (p< 0.05). As the result, the application of TENS in GCM clinically decreases the postural sway with visual input it helps to stable posture control and prevent to falling down.

  14. [Skin sparing mastectomy and immediate breast reconstruction].

    PubMed

    Liu, Ligang; Wu, Yongjin; Wang, Liang

    2004-11-01

    To investigate the results of skin sparing mastectomy and immediate breast reconstruction with transverse rectus abdomins musculotaneous (TRAM) flap or latissimus dorsi musculocutaneous flap plus placement of a mammary implant. From June 1997 to June 2002, 11 patients were proven to have ductal carcinoma in situ or huge breast carcinoid by pathological examination. The site of the biopsy incision was around the areola. The patients underwent mastectomy with skin sparing by a circumareolar incision and immediate breast reconstruction with TRAM flap or latissimus dorsi musculocutaneous flap plus placement of mammary implant. Autogenous tissue was used to fill the skin envelop. The second stage operation of nipple-areola reconstruction was performed on the replaced skin. Eleven patients were followed up 1 month to 6 years. The operative result was good and all patients had no relapse. The reconstructed breast achieved good results in shape, colour, sensation, symmetry and incision scar. The skin sparing mastectomy and immediate autograft tissue breast reconstruction is an ideal reconstructive method for the patients with breast ductal carcinoma in situ or huge breast carcinoid in condition that there were strict operative indication and relapse can be prevented.

  15. Movement related cortical source for elbow flexion in patients with branchial plexus injury after intercostal-musculocutaneous nerve crossing.

    PubMed

    Kanamaru, A; Homma, I; Hara, T

    1999-10-29

    Nine patients with brachial plexus injury whose transected musculo-cutaneous nerves had been sutured with intercostal nerves were examined and the relationship between flexion of the operated elbow and the respiratory movement were shown. Three out of nine patients showed independent control of movement from respiration after regeneration. The primary motor cortex for either flexion of the elbow to the operated side or brisk voluntary inspiration was estimated in the medial vertex region of the frontal cortex by the dipole-tracing method in these three patients. The present results suggest that patients contract the biceps muscle reinnervated by the intercostal nerve independently from respiratory movements using the same primary motor cortex with trunk movements. Functional plasticity may occur in the patients using the primary trunk motor cortex for elbow flexion.

  16. Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap.

    PubMed

    Kaartinen, Ilkka S; Vuento, Maarit H; Hyöty, Marja K; Kallio, Jukka; Kuokkanen, Hannu O

    2015-01-01

    Total pelvic exenteration (TPE) is a rare operation in which the pelvic contents are removed entirely. Several options for pelvic floor and vaginal reconstruction have been described including transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. The transverse musculocutaneous gracilis (TMG) flap has been introduced for breast reconstruction as a free flap. We adopted the pedicled TMG flap for reconstructions after TPE. To the best of our knowledge, this is the first report of this method in the literature. Between November 2011 and February 2014, 12 patients underwent TPE and reconstruction with unilateral (six patients) or bilateral (six patients) pedicled TMG flaps. Five patients underwent vaginal reconstruction with bilateral TMG flaps. We describe the operative procedure and the outcome of the operation in these patients. The total mean operative times for TPE with or without vaginal reconstruction were 467 ± 12 and 386 ± 59 min, respectively. The TMG flaps had enough vascular tissue and mobility for reconstructing the TPE defects. There was distal edge necrosis in one out of 18 flaps, while the rest survived completely. During the follow-up, complete wound healing with no signs of weakening of the pelvic floor was observed in all cases. Soft-tissue reconstructions are needed to reduce complications associated with TPE, to secure the pelvic floor and to reconstruct the vagina in select patients. The TMG flap is a logical flap choice that does not lead to functional deficits, complicate the abdominal ostomies or weaken the abdominal wall. It reduces the length of operation compared to that of abdominal flaps. IV, therapeutic. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Lattisimus Dorsi Transfer assisted by arthroscopy for the treatment of irreparable posterolateral Rotator Cuff Tears

    PubMed Central

    Muiño, José María Silberberg; Gimenez, Martín Alejandro; Salvucci, Mauro Gabriel Maroa; Ferro, Diego; Rullan, Ramón Muiña

    2017-01-01

    Objective: To evaluate subjective and functional mid term results of patients treated by a lattisimus dorsi tendón transfer arthroscopically assisted for massive irreparable posterolateral injuries of the Rotator Cuff. Methods: Between 2009 and 2012, 17 Lattisimus Dorsi transfers (Paribelli technique) for irreparable posterolateral rotator cuff tears were performed. Distribution by sex: 12 men and 5 women with a mean age of 53 years old (range, 40-63). Thirteen right shoulders and 4 left shoulders. Average duration of symptoms prior to surgery was 8 months (range, 6-13 months). Mean follow-up was 28 months (range, 18-44). Patients were evaluated by the VAS, satisfaction rate, the Constant Modified Scale, postoperative range of motion and strength. Postoperative radiological studies included simple AP radiographs and MRI in order to measure AC distance and asses the integrity of the plasty. Results: Postoperative Constant Modified score averaged 63.54 points. (average increase of 13 points compared to preoperative score. (P ..05)). Active Mobility: a) Mean elevation: 142° postop vs. 119° preop (p <.001). b) Mean abduction: 138.24º postop vs. 112.35º preop (p <.001). c) Mean external rotation 40° postop vs. 20.29º preop (p <.004). Insert text. Conclusion: Lattisimus Dorsi transfer in patients with posterolateral massive irreparable injuries of the RC, is a highly demanding and palliative procedure for those cases with loss of active mobility, especially lifting and shoulder abduction.

  18. Satisfactory elbow flexion in complete (preganglionic) brachial plexus injuries: produced by suture of third and fourth intercostal nerves to musculocutaneous nerve.

    PubMed

    Minami, M; Ishii, S

    1987-11-01

    The third and fourth intercostal nerves were sutured to the musculocutaneous nerve to restore flexion of the elbow joint in complete (preganglionic) brachial plexus injuries. Seventeen patients were followed on the average for 5 years and 7 months after surgery. The results were evaluated by means of manual muscle tests and electrical diagnostic tests. Good (grade IV), or better, flexion of the elbow joint occurred in 12 patients over 3 years after the operation.

  19. Ciliary neurotrophic factor promotes motor reinnervation of the musculocutaneous nerve in an experimental model of end-to-side neurorrhaphy

    PubMed Central

    2011-01-01

    Background It is difficult to repair nerve if proximal stump is unavailable or autogenous nerve grafts are insufficient for reconstructing extensive nerve damage. Therefore, alternative methods have been developed, including lateral anastomosis based on axons' ability to send out collateral sprouts into denervated nerve. The different capacity of a sensory or motor axon to send a sprout is controversial and may be controlled by cytokines and/or neurotrophic factors like ciliary neurotrophic factor (CNTF). The aim of the present study was to quantitatively assess collateral sprouts sent out by intact motor and sensory axons in the end-to-side neurorrhaphy model following intrathecal administration of CNTF in comparison with phosphate buffered saline (vehiculum) and Cerebrolysin. The distal stump of rat transected musculocutaneous nerve (MCN) was attached in an end-to-side fashion with ulnar nerve. CNTF, Cerebrolysin and vehiculum were administered intrathecally for 2 weeks, and all animals were allowed to survive for 2 months from operation. Numbers of spinal motor and dorsal root ganglia neurons were estimated following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to ulnar and musculocutaneous nerve, respectively. Reinnervation of biceps brachii muscles was assessed by electromyography, behavioral test, and diameter and myelin sheath thickness of regenerated axons. Results Vehiculum or Cerebrolysin administration resulted in significantly higher numbers of myelinated axons regenerated into the MCN stumps compared with CNTF treatment. By contrast, the mean diameter of the myelinated axons and their myelin sheath thickness in the cases of Cerebrolysin- or CNTF-treated animals were larger than were those for rats treated with vehiculum. CNTF treatment significantly increased the percentage of motoneurons contributing to reinnervation of the MCN stumps (to 17.1%) when compared with vehiculum or Cerebrolysin treatments (at 9.9 or 9

  20. [Nerve transfer between the intercostal nerves and the motor component of the musculocutaneous nerve. Anatomical study of feasibility].

    PubMed

    Fleury, M; Lepage, D; Pluvy, I; Pauchot, J

    2017-06-01

    The intercostal nerves (ICN) transfer to the musculocutaneous nerve (MCN) can restore elbow flexion in complete brachial plexus palsy. The last cases our service dealt with, allowed our staff to observe two different situations. In the 2 first patients, we were able to proceed with an intraneurodissection of the MCN motor component up to the axillary cavity level, while on the third case such dissection could not be performed as high. The aim of this work is to assess the feasibility of a transfer on the MCN's motor component. We conducted a series of 5 cadaver dissections of the MCN and ICN on the anatomy laboratory. Using magnifying loupes to perform an intraneurodissection, we were able to split the motor and sensory fibers as they stood out. It would help motor recuperation avoiding directional error on sensitive component. The ICN can be sutured on the motor component of the MCN, provided the dissection is very minutious. The intraneurodissection of the MCN up to the axillary cavity level is possible as the interfascicular exchanges are scarce there. Publications already refer to the possibility of a nerve transfer between the ICN and the motor component of the MCN. Therefore, our researches suggest that such a procedure can be considered for routine procedures. The neurotization is one of the latest breakthroughs in terms of brachial plexus surgery. We are hopeful that anatomical researches could lead to optimization possibilities. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy.

    PubMed

    Kawabata, H; Shibata, T; Matsui, Y; Yasui, N

    2001-03-01

    The use of intercostal nerves (ICNs) for the neurotization of the musculocutaneous nerve (MCN) in adult patients with traumatic brachial plexus palsy has been well described. However, its use for brachial plexus palsy in infants has rarely been reported. The authors surgically created 31 ICN-MCN communications for birth-related brachial plexus palsy and present the surgical results. Thirty-one neurotizations of the MCN, performed using ICNs, were conducted in 30 patients with birth-related brachial plexus palsy. In most cases other procedures were combined to reconstruct all upper-extremity function. The mean patient age at surgery was 5.8 months and the mean follow-up period was 5.2 years. Intercostal nerves were transected 1 cm distal to the mammary line and their stumps were transferred to the axilla, where they were coapted directly to the MCN. Two ICNs were used in 26 cases and three ICNs in five cases. The power of the biceps muscle of the arm was rated Grade M4 in 26 (84%) of 31 patients. In the 12 patients who underwent surgery when they were younger than 5 months of age, all exhibited a grade of M4 (100%) in their biceps muscle power. These results are better than those previously reported in adults. Neurotization of the MCN by surgically connecting ICNs is a safe, reliable, and effective procedure for reconstruction of the brachial plexus in patients suffering from birth-related palsy.

  2. Using a pedicle pectoralis major musculocutaneous flap in head and neck reconstruction after modified radical mastectomy: A case report.

    PubMed

    Huang, Jen-Wu; Wu, Nai-Yuan; Lin, Yi-Ying

    2017-04-01

    A pedicle pectoralis major musculocutaneous (PMMC) flap is one of the strategies for head and neck reconstruction. Seldom studies reported the case in which the skin area of previous modified radical mastectomy (MRM) had been used as a PMMC flap in head and neck reconstruction. An 84-year-old female who had suffered from left breast cancer and undergone a left modified radical mastectomy (MRM) more than 20 years earlier. She had squamous cell carcinoma of the tongue and had undergone partial glossection and left modified radial neck dissection. Four months later, a left submandibular mass was noted with progressive enlargement and the biopsy revealed recurrent carcinoma. Left marginal mandibulectomy with radical neck dissection was performed and the neck area was reconstructed by a left pedicle PMMC flap harvested from the left chest wall which had the previous MRM scar. The post-operative course was uneventful with complete survival of the flap. The patient received post-operative adjuvant radiotherapy at the left neck and no delayed wound disruption or flap necrosis was noted six months after surgery. A pedicle PMMC flap may be harvested to achieve a functionally as well as an aesthetically pleasing outcome without compromising its viability despite the previous MRM.

  3. Methylcobalamin, but not methylprednisolone or pleiotrophin, accelerates the recovery of rat biceps after ulnar to musculocutaneous nerve transfer.

    PubMed

    Liao, W-C; Chen, J-R; Wang, Y-J; Tseng, G-F

    2010-12-15

    Using ulnar nerve as donor and musculocutaneous nerve as recipient we recently demonstrated that end-to-end neurorrhaphy in young adult male Wistar rats resulted in good recovery following protracted survival. Here we explored whether anti-inflammatory drug- methylprednisolone, regeneration/myelination-enhancing agent- methylcobalamin and neurite growth-enhancing and angiogenic factor- pleiotrophin accelerated its recovery. Methylprednisolone suppressed the perineuronal microglial reaction and periaxonal ED-1 expression while pleiotrophin increased the blood vessel density and nerve fiber densities in the reconnected nerve as expected. Neither methylprednisolone nor methylcobalamin altered the expression of growth associated protein 43 in the neurons examined suggesting that they did not interfere with axonal regeneration attempt. Surprisingly methylcobalamin enhanced the recovery of compound muscle action potentials and motor end plate innervation and the performance on sticker removal grooming test and augmented the diameters and myelin thicknesses of regenerated axons dramatically while enhancing S-100 expression in Schwann cells; remarkable recovery was achieved 1 month following neurorrhaphy. Simultaneous methylcobalamin and pleiotrophin treatment resulted in quick and persistent supernumerary reinnervation but failed to enhance the recovery over that of the former alone. Methylprednisolone transiently suppressed the enumeration of regrowing axons. In conclusion, methylcobalamin may be preferred over methylprednisolone to facilitate the recovery of peripheral nerves following end-to-end neurorrhaphy. The long-term effect of this treatment however remains to be clarified. Copyright © 2010 IBRO. Published by Elsevier Ltd. All rights reserved.

  4. Microstructural and mechanical properties of camel longissimus dorsi muscle during roasting, braising and microwave heating.

    PubMed

    Yarmand, M S; Nikmaram, P; Djomeh, Z Emam; Homayouni, A

    2013-10-01

    This study was conducted to investigate the effects of various heating methods, including roasting, braising and microwave heating, on mechanical properties and microstructure of longissimus dorsi (LD) muscle of the camel. Shear value and compression force increased during microwave heating more than roasting and braising. Results obtained from scanning electron microscopy (SEM) showed more damage from roasting than in either braising or microwave heating. Granulation and fragmentation were clear in muscle fibers after roasting. The perimysium membrane of connective tissue was damaged during braising, while roasting left the perimysium membrane largely intact. The mechanical properties and microstructure of muscle can be affected by changes in water content during cooking.

  5. Fatty acid composition of subcutaneous and intramuscular adipose tissues and M. longissimus dorsi of Wagyu cattle.

    PubMed

    Sturdivant, C A; Lunt, D K; Smith, G C; Smith, S B

    1992-01-01

    Three experiments were conducted to document the fatty acid composition of tissues from purebred Wagyu cattle from Japan and North American crossbred Wagyu. In experiment 1, subcutaneous (s.c.) adipose tissues (n = 23) were obtained from Japanese cattle representing the five Japanese fat quality grades. The monounsaturated:saturated fatty acid ratio (MUFA:SFA) was greatest in fat quality grade 5 samples (2·57) and least in the fat quality grade 3 samples (2·08; P < 0·05). In experiment 2, M. longissimus dorsi and the associated intramuscular (i.m.) and s.c. adipose tissues were obtained from carcasses of Wagyu crossbred steers (1/2-7/8) raised in the USA. Fatty acid composition varied among depots, but the MUFA:SFA ratio in s.c. adipose tissue (1·46) was not different from values reported for other breeds of cattle. In experiment 3, samples of M. longissimus dorsi ribsteaks were obtained from three regions in Japan. Samples from the Gunma region had the greatest (P < 0·05) MUFA:SFA ratio (2·10), relative to samples from the Kagoshima (1·82) and Miyazaki (1·65) regions. The data indicate that beef from purebred Wagyu cattle raised in Japan is enriched in monounsaturated fatty acids, and that the degree of enrichment depends upon the region of Japan from which the samples were obtained.

  6. Tenderization of Bovine Longissimus Dorsi Muscle using Aqueous Extract from Sarcodon aspratus

    PubMed Central

    Kim, Ho-Kyoung; Lee, Sang-Hoon

    2015-01-01

    The aim of this study was to investigate the effects of aqueous extract from Sarcodon aspratus on tenderization of the bovine longissimus dorsi muscles in comparison with commercial proteolytic enzymes. Furthermore, meat quality and muscle protein degradation were examined. We marinated meat with 2% Sarcodon aspratus extract, 2% kiwi extract, and 0.2% papain. Beef chunks (3×3×3 cm3) were marinated with distilled water (control), Sarcodon aspratus extract (T1), kiwi extract (T2) or papain (T3) for 48 h at 4℃. There were no significant differences in muscle pH and lightness between control and treated samples. T1 had the lowest redness (p<0.01), and higher cooking loss and water holding capacity than control and T2 (p<0.05). T1 and T3 exhibited lower shear force values than control (p<0.05). Total protein solubility did not differ significantly between T1 and control, but T1 had less myofibrillar protein solubility than control and T2 (p<0.001). The degradation of myosin heavy chain in T1 and T3 was observed. This degradation of myofibrillar protein suggests that Sarcodon aspratus extract could influence tenderization. These results show that aqueous extract of Sarcodon aspratus extract actively affect the tenderness of the bovine longissimus dorsi muscle. PMID:26761876

  7. Recurrence after skin-sparing mastectomy and immediate transverse rectus abdominis musculocutaneous flap reconstruction for invasive breast cancer

    PubMed Central

    2013-01-01

    Background The aim of this study was to evaluate the recurrence pattern after skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) using transverse rectus abdominis musculocutaneous (TRAM) flap in patients with invasive breast cancer. Methods From 1995 to 2010, patients with invasive breast cancer who underwent SSM followed by IBR using TRAM flap were retrospectively reviewed. The pattern of the first recurrence event was recorded. Results We identified 249 consecutive patients with invasive breast cancer, two-thirds of whom (67.1%) were diagnosed with stage II or stage III disease. During a median follow-up period of 53 months, three (1.2%) local, 13 (5.2%) regional, 34 (13.7%) distant, and five (2.0%) concurrent locoregional and distant recurrences were observed. The median time to recurrences was 26 months (range, 2 to 70 months) for all recurrences, 23 months (range, 2 to 64 months) for locoregional recurrences, and 26 months (range, 8 to 70 months) for distant recurrences. All local recurrent lesions were detectable by careful physical examination, and detection of local recurrence suggested the presence of distant metastasis (60.0%). In contrast to distant metastasis, the risk of locoregional recurrence did not increase significantly with an increase in disease stage. The 5-year overall, locoregional relapse-free, and distant relapse-free survival rates were 89.7%, 90.8%, and 81.6%, respectively. Conclusions SSM followed by immediate reconstruction using TRAM flap is an oncologically safe procedure even in patients with advanced-stage disease. Detection of local recurrence is crucial and can be aided by a thorough physical examination. PMID:23945398

  8. Recurrence after skin-sparing mastectomy and immediate transverse rectus abdominis musculocutaneous flap reconstruction for invasive breast cancer.

    PubMed

    Liang, Tsung-Jung; Wang, Being-Whey; Liu, Shiuh-Inn; Yeh, Ming-Hsin; Chen, Yu-Chia; Chen, Jin-Shyr; Mok, King-Tong; Chang, Hong-Tai

    2013-08-14

    The aim of this study was to evaluate the recurrence pattern after skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) using transverse rectus abdominis musculocutaneous (TRAM) flap in patients with invasive breast cancer. From 1995 to 2010, patients with invasive breast cancer who underwent SSM followed by IBR using TRAM flap were retrospectively reviewed. The pattern of the first recurrence event was recorded. We identified 249 consecutive patients with invasive breast cancer, two-thirds of whom (67.1%) were diagnosed with stage II or stage III disease. During a median follow-up period of 53 months, three (1.2%) local, 13 (5.2%) regional, 34 (13.7%) distant, and five (2.0%) concurrent locoregional and distant recurrences were observed. The median time to recurrences was 26 months (range, 2 to 70 months) for all recurrences, 23 months (range, 2 to 64 months) for locoregional recurrences, and 26 months (range, 8 to 70 months) for distant recurrences. All local recurrent lesions were detectable by careful physical examination, and detection of local recurrence suggested the presence of distant metastasis (60.0%). In contrast to distant metastasis, the risk of locoregional recurrence did not increase significantly with an increase in disease stage. The 5-year overall, locoregional relapse-free, and distant relapse-free survival rates were 89.7%, 90.8%, and 81.6%, respectively. SSM followed by immediate reconstruction using TRAM flap is an oncologically safe procedure even in patients with advanced-stage disease. Detection of local recurrence is crucial and can be aided by a thorough physical examination.

  9. Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years

    PubMed Central

    2013-01-01

    Background Ankle strength is often impaired in some of the most common neuromuscular disorders. Consequently, strength generated around this joint is important to assess, because it has a great impact on balance and gait. The objectives of this study were to establish normative data and predictive equations for both ankle dorsi- and plantar-flexion strength from a population of healthy subjects (children and adults), to assess the reliability of the measurements and to study the feasibility of using a novel dynamometer on a group of patients with a neuromuscular disorder. Methods Measurements of maximal isometric torque for dorsi- and plantar-flexion were performed on 345 healthy subjects from 5 to 80 years of age. The feasibility of the method was tested on nine patients diagnosed with type 2A limb girdle muscular dystrophy. Results The results documented normal strength values depending on gender and age on ankle dorsi- and plantar-flexion. The reliability of the technique was good with no evaluator effect and a small learning effect. The dynamometer was found suitable in the group of patients, even very weak. Conclusions The device developed was both reliable and accurate in assessing both ankle dorsi-flexion and plantar-flexion torque measurements from weak patients and children to strong healthy adults. Norms and predictive equations are provided for these two muscle functions. PMID:23522186

  10. [Thigh and leg musculo-cutaneous island flap for giant bilateral trochanteric and perineal pressure sores coverage: Extreme treatment in spinal cord injury].

    PubMed

    André, A; Crouzet, C; De Boissezon, X; Grolleau, J-L

    2015-06-01

    Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left trochanteric pressure sore. The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Intercostal nerve transfer to neurotize the musculocutaneous nerve after traumatic brachial plexus avulsion: a comparison of two, three, and four nerve transfers.

    PubMed

    Xiao, Chengwei; Lao, Jie; Wang, Tao; Zhao, Xin; Liu, Jingbo; Gu, Yudong

    2014-06-01

    The purpose of this study was to compare the outcomes of different numbers of intercostal nerve (ICN) transfers for elbow flexion and to determine whether age, body mass index (BMI), type of injury, and preoperative delay influence the outcomes. From 2004 to 2010, 32 (30 included) consecutive patients underwent ICN transfer to the musculocutaneous nerve following brachial plexus injury. Elbow flexion strength was evaluated according to the British Medical Research Council (BMRC) grading system. Of nine patients who received two ICN transfers, six (66.7%) recovered with useful elbow flexion compared with 14 of 17 (82.4%) patients who received three ICN transfers. Of the four patients with four ICN transfers, three (75%) achieved useful recovery. Statistical analysis showed no significant difference. There is no significant difference among the outcomes of two, three, and four ICN transfers to the musculocutaneous nerve. Two ICN transfers are sufficient for useful recovery of elbow flexion. Younger patients achieve better results. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    PubMed

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  13. Textural effect of chilling hot Longissimus dorsi muscle with solid CO(2).

    PubMed

    Swain, M V; Gigiel, A J; Limpens, G

    1999-04-01

    This paper covers the work carried out on the textural effects of chilling hot boned meat using solid carbon dioxide (CO(2)). The purpose was to measure the texture of beef Longissimus dorsi (LD) chilled in boxes with solid CO(2) and to compare this with conventionally chilled meat. The results showed that CO(2) chilled meat were tougher than the controls. Shear force (SF) and work done (WD) results indicated that 63% of the CO(2) chilled meat were above 50N compared to 32% of the controls, taste panel would judge this as slightly tough. 22% of the CO(2) chilled meat was SF>100N which overall would be judged as extremely tough as compared to 2% of the controls. The work also showed that the laser diffraction technique was unable to distinguish between active and passive shortening giving only an average or overall length for the area viewed.

  14. Changes in meat quality of ovine longissimus dorsi muscle in response to repeated freeze and thaw.

    PubMed

    Qi, Jun; Li, Chunbao; Chen, Yinji; Gao, Feifei; Xu, Xinglian; Zhou, Guanghong

    2012-12-01

    Changes in eating and technological quality attributes of ovine longissimus dorsi muscle during repeated freeze and thaw were investigated. Shear force value, L* value, a* value and fiber diameter decreased (P<0.05) but lipid oxidation increased (P<0.05) with repeated freeze-thaw cycles. Sarcomere length and pH decreased (P<0.05) within the first 10 freeze-thaw cycles but increased (P<0.05) after 5 further cycles. Total and myofibrillar protein solubility, and intramuscular free fatty acids concentration decreased (P<0.05) after 1 cycle of freeze and thaw but then increased (P<0.05) gradually with further cycles. Hardness, chewiness, cohesiveness and resilience of comminuted lamb products decreased (P<0.05) with increased freeze-thaw cycles. And therefore, repeated freeze and thaw should be minimized in terms of meat color for commercial value and water holding capacity for further processing.

  15. Detection of quantitative trait loci for mineral content of Nelore longissimus dorsi muscle.

    PubMed

    Tizioto, Polyana C; Taylor, Jeremy F; Decker, Jared E; Gromboni, Caio F; Mudadu, Mauricio A; Schnabel, Robert D; Coutinho, Luiz L; Mourão, Gerson B; Oliveira, Priscila S N; Souza, Marcela M; Reecy, James M; Nassu, Renata T; Bressani, Flavia A; Tholon, Patricia; Sonstegard, Tad S; Alencar, Mauricio M; Tullio, Rymer R; Nogueira, Ana R A; Regitano, Luciana C A

    2015-03-11

    Beef cattle require dietary minerals for optimal health, production and reproduction. Concentrations of minerals in tissues are at least partly genetically determined. Mapping genomic regions that affect the mineral content of bovine longissimus dorsi muscle can contribute to the identification of genes that control mineral balance, transportation, absorption and excretion and that could be associated to metabolic disorders. We applied a genome-wide association strategy and genotyped 373 Nelore steers from 34 half-sib families with the Illumina BovineHD BeadChip. Genome-wide association analysis was performed for mineral content of longissimus dorsi muscle using a Bayesian approach implemented in the GenSel software. Muscle mineral content in Bos indicus cattle was moderately heritable, with estimates ranging from 0.29 to 0.36. Our results suggest that variation in mineral content is influenced by numerous small-effect QTL (quantitative trait loci) but a large-effect QTL that explained 6.5% of the additive genetic variance in iron content was detected at 72 Mb on bovine chromosome 12. Most of the candidate genes present in the QTL regions for mineral content were involved in signal transduction, signaling pathways via integral (also called intrinsic) membrane proteins, transcription regulation or metal ion binding. This study identified QTL and candidate genes that affect the mineral content of skeletal muscle. Our findings provide the first step towards understanding the molecular basis of mineral balance in bovine muscle and can also serve as a basis for the study of mineral balance in other organisms.

  16. Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study.

    PubMed

    Monrigal, E; Dauplat, J; Gimbergues, P; Le Bouedec, G; Peyronie, M; Achard, J L; Chollet, P; Mouret-Reynier, M A; Nabholtz, J M; Pomel, C

    2011-10-01

    To evaluate the feasability of immediate breast reconstruction (IBR) following mastectomy after neoadjuvant chemotherapy (NACT) and radiation therapy (RT) for operable invasive breast cancer (OIBC), in terms of incidence of local complications, locoregional control and survival. From 1990 to 2008, 210 patients were treated by NACT, RT and mastectomy with IBR for OIBC. One hundred and seven patients underwent a latissimus dorsi flap with implant (LDI), 56 patients a transverse rectus abdominis musculocutaneous (TRAM) flap, 25 an autologous latissimus dorsi flap (ALD) and 22, a retropectoral implant (RI) reconstruction. Forty-six (21.9%) early events were recorded: 20 necrosis, 9 surgical site infections and 6 haematomas, requiring further surgery in 23 patients. More necrosis were observed with TRAM flap reconstructions (p = 0.000004), requiring more surgical revision than LD reconstructions. Seromas represented 42% of early complications in LD reconstructions. Fifty-five patients presented with late complications (26.2%) with mainly implant complications (capsular contracture, infection, dislocation, deflation) (23.6%), requiring reintervention in 14 cases. There were more delayed surgical revisions in RI reconstructions (p = 0.0005). The 5 years overall and disease-free survival rates were respectively 86.7% and 75.6%. Sixty-four patients presented at least one recurrence (30.5%) with 5 local, 9 locoregional and 54 distant relapses. This therapeutic sequence does not seem to increase the IBR morbidity nor alter disease-free and overall survival. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Face transplant: is it feasible in developing countries?

    PubMed

    González-García, Ignacio; Lyra-González, Iván; Medina-Preciado, David; Guerrero-Torres, Alejandro; Ramos-Gallardo, Guillermo; Armendáriz-Borunda, Juan

    2013-01-01

    This article is based on the case of a 28-year-old woman who was involved in a car accident, with diagnosis of polytrauma, loss of left eye, and second- and third-degree burns over the left midface, rendering an exposed area of 8 cm wide and 19 cm length, ranging from glabella to mandible, with skull exposure and loss of left eye.A latissimus dorsi musculocutaneous free flap was transferred into the defect; left eye and nose prosthetics were necessary to restore normal appearance. Excellent results were obtained; reinsertion to patient's normal life and reinstatement of facial appearance were achieved with minimal costs and no postsurgical complications.Analysis of the current situation in developing countries demonstrates that technique and infrastructure do not represent a real challenge to carry on face transplants. However, socioeconomic reality in these societies makes it difficult to establish face transplant as a feasible therapeutic opportunity for the overwhelming majority of patients who are victims of severe facial damage.Therefore, strategies such as latissimus dorsi free flap remains as an excellent therapy to face off our complex facial reconstructive challenges in developing countries such as Mexico.

  18. [Use of vascularized free flaps for reconstruction of oncological defects in the head and neck].

    PubMed

    Roman, L D; Karpenko, A V; Sidgatullin, R R; Belova, E N; Chumanikhina, N S; Dzhalilov, D N

    2012-01-01

    The aim of the study is to assess our results with free flap transfer. Since October, 2005 till December, 2011 51 operations were performed. Mucosa of upper digestive tract was reconstructed in 40 cases, soft tissues and skin of the head and neck region-in 11 cases. Reconstruction was primary in all but 2 cases. 18 first cases were performed with 2,5x and 4x binocular loupes magnification. Operating microscope was used in another 33 cases. 37 radial forearm fasciocutaneous flaps, 5 latissimus dorsi musculocutaneous flaps, 7 anterolateral thigh flaps, 1 scapular osteocutaneous were used with the single case of visceral flap--jejunal free flap. Death in early postoperative period occurred once. Complete flap loss occurred six times. Five radial and one latissimus dorsi free flaps were lost. Arterial thrombosis is considered as a primary cause of failure in one case, venous thrombosis-in two cases. Severe postoperative infection was considered as a primary cause of failure in one case. In remaining 2 cases the cause of flap loss could not be determined exactly. There were three cases of revision surgery with attempts to reperform venous anastomosis, one of them was successful. Overall success rate in this series is 86,3 %. The main cause of such a low rate of success is a lack of experience.

  19. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    NASA Astrophysics Data System (ADS)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  20. Long-term results of through-knee amputation with dorsal musculocutaneous flap in patients with end-stage arterial occlusive disease.

    PubMed

    Kock, Hans-Juergen; Friederichs, Jan; Ouchmaev, Alexander; Hillmeier, Joachim; Von Gumppenberg, Stephan

    2004-08-01

    A modified technique of knee joint disarticulation using a dorsal musculocutaneous flap of the gastrocnemius muscle was first described in 1985. The operative results in 66 patients (33 women, 33 men; mean age 66.7 +/- 11.3 years, range 42-93 years) with gangrene due to peripheral vascular disease with 69 knee disarticulations are reported. After a mean survival period of 35.2 months (0-116 months), 88% ( n = 58) of the patients had died owing to cardiopulmonary reasons. The in-hospital 48-day mortality was 9%. Nine patients (14%) underwent reamputation at the above-knee level, and five patients underwent operative revision of the soft tissue. After discharge from the hospital, 35 of 60 patients (58%) were able to walk with the aid of a prosthesis. We conclude that knee disarticulation with the use of a myocutaneous gastrocnemius flap is a safe, functionally acceptable operative method in high risk vascular patients.

  1. Comparison of fat necrosis between zone II and zone III in pedicled transverse rectus abdominis musculocutaneous flaps: a prospective study of 400 consecutive cases.

    PubMed

    Kim, Eun Key; Lee, Taik Jong; Eom, Jin Sup

    2007-09-01

    Fat necrosis in transverse rectus abdominis musculocutaneous (TRAM) flap is considered to be mainly affected by blood supply. This prospective study compares the incidence of fat necrosis between zones II and III in 400 consecutive patients who had undergone unipedicled TRAM flap breast reconstruction. Fifty-eight patients (14.5%) suffered from fat necrosis, and 7 had 2 separate nodules. Fifty-four occurred in zone II, 10 in zone III, and 1 in zone I. The incidence of fat necrosis in zone II was significantly higher than in zone III (P < 0.001). The weight of the mastectomy specimen and the relative amount of zone II tissue included in the flap had positive correlation with the incidence of fat necrosis. This result implies relatively poor perfusion of zone II compared with zone III.

  2. Expression of MMP-1, -2, and -8 in longissimus dorsi muscle and their relationship with meat quality traits in cattle.

    PubMed

    Qi, Y X; Zhang, X H; Wang, Y Q; Pang, Y Z; Zhang, Z B; Zhang, T L; Zhang, Z X

    2016-03-04

    The extracellular matrix (ECM) is the major macromolecule in skeletal muscle, which affects meat quality greatly. The remodeling of the ECM is mainly regulated by matrix metalloproteinases (MMPs). The expression patterns of MMP-1, -2, and -8 in longissimus dorsi muscle were explored using quantitative real-time polymerase chain reaction. The results show that the expression of MMP-1, -2, and -8 decreased significantly from 135 days of pregnancy to postnatal 30 months. While the expression of MMP-1, -2, and -8 showed no significant relationships with intramuscular fat contents, MMP-1 and -2 showed significant negative correlations with the shearing force of the longissimus dorsi muscle in cattle. The expression of MMP-1 also showed a significant negative correlation with cooking loss and a positive correlation with water holding capacity. The expression levels of MMP-1 and -2 were usually higher in fat than in skeletal muscle tissue. The expression of MMP-8 was significantly higher in the mammary fat pad and the longissimus dorsi muscle than in all other tissues. This study indicates that the remodeling of the ECM has important effects both on the development of postnatal skeletal muscle and on meat quality.

  3. Laser photobiomodulation (830 and 660 nm) in mast cells, VEGF, FGF, and CD34 of the musculocutaneous flap in rats submitted to nicotine.

    PubMed

    das Neves, Lais Mara Siqueira; Leite, Gabriella de Paula Marcondes Ferreira; Marcolino, Alexandre Marcio; Pinfildi, Carlos Eduardo; Garcia, Sérgio Britto; de Araújo, João Eduardo; Guirro, Elaine Caldeira de Oliveira

    2017-02-01

    The aim of this study was to investigate the effect of laser photobiomodulation (PBM) on the viability of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats subjected to the action of nicotine. We evaluated 60 albino Wistar rats, divided into six groups of ten animals. Group 1 (saline) underwent the surgical technique to obtain a TRAM flap; group 2 (laser 830 nm) underwent the surgical technique and was irradiated with a laser 830 nm; group 3 (laser 660 nm) underwent the surgical technique and was irradiated with a laser 660 nm; group 4 was treated with nicotine subcutaneously (2 mg/kg/2×/day/4 weeks) and underwent surgery; group 5 (nicotine + laser 830 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 830 nm; group 6 (nicotine + laser 660 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 660 nm. The application of PBM occurred immediately after surgery and on the two following days. The percentage of necrosis was assessed using the AxioVision® software. The number of mast cells (toluidine blue staining) was evaluated, and immunohistochemistry was performed to detect vascular endothelial growth factor expression (anti-VEGF-A), fibroblasts (anti-basic FGF), and neoformed vessels (anti-CD34). PBM with a wavelength of 830 nm increased the viability of the TRAM flap, with a smaller area of necrosis, increased number of mast cells, and higher expression of VEGF and CD34. PBM increases the viability of musculocutaneous flaps treated with to nicotine.

  4. Lambeau musculocutané infra hyoidien à palette cutané horizontale pour un angiomyxome agressif de la face interne de la joue

    PubMed Central

    Kettani, Mounir; Touihem, Nabil; Attifi, Hicham; Hmidi, Mounir; Boukhari, Ali; Zalagh, Mohamed; Messary, Abdelhamid

    2014-01-01

    Décrit par Wang en 1986, le lambeau musculocutané infra hyoidien est vascularisé par l'artère thyroïdienne supérieure et comporte les muscles sternohyoïdien, sternothyroïdien et le chef supérieur du muscle Omo hyoïdien. Le prélèvement horizontal de la palette cutanée ne modifie pas la fiabilité du lambeau et permet d’éviter des cicatrices supplémentaires. L'angiomyxome agressif est une tumeur mésenchymateuse développée aux dépens du tissu conjonctif avec un site de prédilection pour les parties molles du périné féminin. Cette tumeur croit progressivement mais n'est pas métastatique. Le traitement indiqué actuellement est l'exérèse chirurgicale large. La tumeur a une tendance à la récidive locale, qui est fréquente, liée à la difficulté d'une exérèse initiale complète. Nous rapportons le cas d'un angiomyxome agressif de la joue chez un patient de 63 ans, qui a été traité par chirurgie avec reconstruction par un lambeau musculocutané infra hyoidien à palette cutanée horizontale. Les aspects cliniques, histologiques et thérapeutiques de la tumeur ont été discutés. PMID:25469203

  5. Foot and ankle reconstruction: an experience on the use of 14 different flaps in 226 cases.

    PubMed

    Zhu, Yue-Liang; Wang, Yi; He, Xiao-Qing; Zhu, Min; Li, Fu-Bin; Xu, Yong-Qing

    2013-11-01

    The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap. The free flaps were latissimus musculocutaneous flap, anterolateral thigh musculocutaneous flap, groin flap, lateral arm flap, anterolateral thigh perforator flap, peroneal artery perforator flap, thoracdorsal artery perforator flap, medial arm perforator flap. The sensory nerve coaptation was not performed for all of flaps. One hundred and ninety-four cases were combined with open fractures. One hundred and sixty-two cases had tendon. Among 164 free flaps, 8 flaps were completely lost, in which the defects were managed by the secondary procedures. Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps), ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing, and infection was found in 14 flaps. The donor site complications were seen in 3 cases with the free anterolateral thigh perforator flap transfer. All of limbs were preserved and the patients regained walking and daily activities. All of patients except for one regained protective sensation from 3 to 12 months postoperatively. Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus, dorsal hindfoot and midfoot. Plantar foot, forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap. For the infected wounds with dead spce, the free latissimus dorsi musculocutaneous flap remained to

  6. Spectral absorption index in hyperspectral image analysis for predicting moisture contents in pork longissimus dorsi muscles.

    PubMed

    Ma, Ji; Sun, Da-Wen; Pu, Hongbin

    2016-04-15

    Spectral absorption index was proposed to extract the morphological features of the spectral curves in pork meat samples (longissimus dorsi) under the conditions including fresh, frozen-thawed, heated-dehydrated and brined-dehydrated. Savitzky-Golay (SG) smoothing and multiplicative scatter correction (MSC) were used for calibrating both the spectral reflectance and absorbance values. The absorption values were better than the reflectance values and the calibrated spectra by MSC were better than the raw and SG smoothing corrected spectra in building moisture content predictive models. The optimized partial least square regression (PLSR) model attained good results with the MSC calibrated spectral absorption values based on the spectral absorption index features (R(2)P=0.952, RMSEP=1.396) and the optimal wavelengths selected by regression coefficients (R(2)P=0.966, RMSEP=0.855), respectively. The models proved spectral absorption index was promising in spectral analysis to predict moisture content in pork samples using HSI techniques for the first time.

  7. Effect of high pressure, temperature, and storage on the color of porcine longissimus dorsi.

    PubMed

    Bak, Kathrine Holmgaard; Lindahl, Gunilla; Karlsson, Anders H; Orlien, Vibeke

    2012-12-01

    The color of pork longissimus dorsi high pressure (HP) treated at 200 to 800 MPa at 5 and 20 °C for 10 min was determined to a high degree by pressure level and to a lesser degree by temperature. Severe color changes appeared up to a threshold pressure at 400 MPa. HP treatment at 20 °C compared to 5 °C resulted in meat, which was less red and slightly lighter. Storage at 2 °C for 6 days had no effect on lightness due to no further protein denaturation, but meat HP treated above 300 MPa became significantly less red and more yellow within the first day of storage. Reflectance spectra showed that a short-lived ferrohemochrome myoglobin species was formed during HP treatment at 300 to 800, but transformed into a brown, ferric form of the pigment within the first day of storage. This explains the observed changes in the redness and yellowness after one day of storage.

  8. Fatty acid and transcriptome profiling of longissimus dorsi muscles between pig breeds differing in meat quality.

    PubMed

    Yu, Kaifan; Shu, Gang; Yuan, Fangfang; Zhu, Xiaotong; Gao, Ping; Wang, Songbo; Wang, Lina; Xi, Qianyun; Zhang, Shouquan; Zhang, Yongliang; Li, Yan; Wu, Tongshan; Yuan, Li; Jiang, Qingyan

    2013-01-01

    Fat and lean pig breeds show obvious differences in meat quality characteristics including the fatty acid composition of muscle. However, the molecular mechanism underlying these phenotypes differences remains unknown. This study compared meat quality traits between Lantang (a Chinese indigenous breed) and Landrace (a typical lean breed). The Lantang pigs showed higher L* values and intramuscular fat content, lower pH(45min), pH(24h) and shear force in longissimus dorsi (LD) muscle than Landrace (P < 0.05). Fatty acid analysis demonstrated the lower monounsaturated fatty acids (MUFA) and higher polyunsaturated fatty acids (PUFA) percentage in Lantang LD than that in Landrace LD (P < 0.05). To further identify candidate genes for fatty acid composition, the transcriptome of LD muscle from the two breeds were measured by microarrays. There were 586 transcripts differentially expressed, of which 267 transcripts were highly expressed in Lantang pigs. After the validation by real-time quantitative PCR, 13 genes were determined as candidate genes for fatty acid composition of muscle, including Stearoyl-CoA desaturase (SCD). Then, a SCD over-expression plasmid was transfected into C2C12 cells to reveal the effect of SCD on the fatty acid composition in vitro. The results showed that SCD over-expression significantly increased PUFA proportion, while reduced that of saturated fatty acids (SFA) in C2C12 cells (P < 0.05). In summary, this study compared the differences of fatty acid composition and transcriptome in two breeds differing in meat quality, and further identified the novel role of SCD in the regulation of PUFA deposition.

  9. Uptake of the prostate-specific membrane antigen-targeted PET radiotracer 18F-DCFPyL in elastofibroma dorsi.

    PubMed

    Gorin, Michael A; Marashdeh, Wael; Ross, Ashley E; Allaf, Mohammad E; Pienta, Kenneth J; Pomper, Martin G; Rowe, Steven P

    2017-09-01

    PET imaging using radiotracers that target prostate-specific membrane antigen (PSMA) are increasingly being used in the evaluation of men with prostate cancer (PCa). It is therefore of increasing importance for imaging specialists to recognize potential pitfalls of this novel imaging technique. In this report, we describe a series of benign elastofibroma dorsi with uptake of the PSMA-targeted PET radiotracer F-DCFPyL. We retrospectively analyzed the imaging data of 75 men with PCa who were consecutively imaged with F-DCFPyL PET/CT. Acquired images were reviewed for the presence of radiotracer uptake in the region of the scapular tip adjacent to the chest wall. Only those lesions with discrete radiotracer uptake corresponding to an area on CT with the characteristic appearance of an elastofibroma were considered positive. In total, 18/75 (24.0%) patients had evidence of at least one elastofibroma dorsi on F-DCFPyL PET/CT. Eight (44.4%) of these patients had unilateral lesions, all of which were right sided. Detected lesions had a median maximal diameter of 2.3 cm (range: 1.3-8.4 cm) and a median perpendicular thickness to the chest wall of 0.9 cm (range: 0.6-2.5 cm). The median maximum standardized uptake value of detected lesions was 1.4 (range: 1.1-2.4) and the median maximum standardized uptake value corrected to lean body mass was 1.1 (range: 0.8-1.7). This study is the first to report uptake of a PSMA-targeted PET radiotracer in elastofibroma dorsi. Radiotracer uptake in these benign lesions should not be falsely mistaken as sites of metastatic PCa.

  10. Comparison of longissimus dorsi Fatty Acids Profiles in Gansu Black Yak and Chinese Yellow Cattle Steers and Heifers.

    PubMed

    Zhang, S G; Liu, T; Brown, M A; Wu, J P

    2015-01-01

    Fatty acid (FA) composition of longissimus dorsi intramuscular fat in Black Yak and Chinese Yellow Cattle were evaluated in 44 Black Yak and 41 Chinese Yellow Cattle of both genders. Interactions of species with gender were observed for total saturated fatty acid (SFA), unsaturated fatty acid (UFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), palmitic acid, stearic acid, oleic acid, linolenic acid, arachidonic acid, EPA, and DHA concentrations, as well as PUFA/SFA ratio in the longissimus dorsi (p<0.05). The SFA percentage was greater in yellow cattle than yak in both genders but the species difference in heifers was greater than in steers (p<0.05). Yak had greater UFA, MUFA and PUFA percentages than yellow cattle in both steers and heifers (p<0.05) but the difference between yak and yellow cattle heifers was greater than yak and yellow cattle steers. The percentages of inolenic acid, arachidonic acid, eicosapentaenoic acid, and docosahexaenoic acid; and PUFA/SFA were greater in yak than yellow cattle in both steers and heifers (p<0.05). In addition, the ratio of n-6/n-3 PUFA in yak was lesser than in yellow cattle (p<0.05). These results indicated that FA composition generally differed between yak and yellow cattle but the differences were not the same in heifers as compared to steers. Results also suggested that species differences in FA composition tended to favor Black Yak over Chinese Yellow Cattle, indicating that the longissimus dorsi of Black Yak may have a higher nutritive value than that of Chinese Yellow Cattle and potential for development as a desirable natural product.

  11. Poland syndrome: evaluation and treatment of the chest wall in 63 patients.

    PubMed

    Seyfer, Alan E; Fox, Justin P; Hamilton, Conrad G

    2010-09-01

    Poland syndrome is a sporadic, congenital unilateral absence of the sternocostal head of the pectoralis major muscle that can occur with other ipsilateral chest wall and limb derangements. The chest wall deficiency is primarily cosmetic, its incidence is unknown, male patients may be affected more than female patients, the right side is affected more than the left, and associated comorbidities may exist. Chest wall repair depends on anatomical type and gender. Sixty-three patients with Poland syndrome were divided into two treatment groups by chest wall anatomy and gender. Surgical repair was based on this division. Seventy-six operations were performed by the senior author (A.E.S.) during a 30-year period, and long-term outcomes are presented. Corrective methods included use of custom-made chest wall prostheses, mammary prostheses, latissimus dorsi muscle transfers, transverse rectus abdominis musculocutaneous flaps, sternal/rib reconstruction, or a combination of methods. Follow-up ranged from 1 to 21 years. Two anatomical forms of the disorder are described, each with unique surgical requirements. The simple deformity was effectively repaired with a latissimus dorsi muscle transfer plus, in female patients, a sublatissimus mammary prosthesis. Repair of the complex deformity, in addition to the latissimus transfer, selectively included musculoskeletal chest wall realignment. Custom-made chest wall prostheses carried a higher risk of complications. Poland syndrome of the chest wall exists in two forms: the more common simple variety and a complex form (as originally described by Poland). Repair of the chest wall can be effectively tailored to these anatomical types, gender, and patient preference.

  12. Backfat thickness and longissimus dorsi real-time ultrasound measurements in light lambs.

    PubMed

    Esquivelzeta, C; Casellas, J; Fina, M; Piedrafita, J

    2012-12-01

    The aim of this study was to assess the accuracy of ultrasound measurements for predicting carcass traits in 124 Spanish pascual-type lambs (13 to 16 kg carcass weight). Ultrasound images were taken transversal and longitudinal to the vertebral column and at thoracic (TV; between 12th and 13th ribs) and lumbar (LV; between first and second lumbar vertebrae) locations. Skin thickness, subcutaneous backfat thickness (BFT), and depth (DLD), width (WLD), and area (ALD) of longissimus dorsi were obtained with ImageJ 1.42q software. After slaughter, BFT (TV, 2.30 ± 0.06 mm; LV, 2.46 ± 0.06 mm), DLD (TV, 2.47 ± 0.03 cm; LV, 2.48 ± 0.03 cm), WLD (TV, 4.50 ± 0.04 cm; LV, 4.60 ± 0.04 cm), and ALD (TV, 9.96 ± 0.12 cm(2); LV, 10.19 ± 0.13 cm(2)) were directly measured on the lamb carcass. Correlations between ultrasound and direct carcass measurements were greater than 0.61 for DLD, WLD, and ALD (P < 0.05) whereas they fluctuated between 0.32 and 0.60 for BFT (P < 0.05); moreover, correlations were significantly (P < 0.05) greater for transversal than for longitudinal views. In a similar way, linear regression analyses suggested a moderate underestimation for BFT and lumbar DLD when using real-time ultrasound technologies whereas WLD, ALD, and thoracic DLD suffered from under- and overestimation for small and large values of carcass traits, respectively. After decomposing the mean square prediction error (MSPE) for the different ultrasound measurements, we found that the error due to disturbance contributed most to the MSPE followed by the error of central tendency and the error due to regression. The SE of prediction (SEP) was also calculated as an additional precision indicator, obtaining estimates less than that in previous studies with larger lambs. In conclusion, transversal ultrasound measurements at the thoracic and lumbar levels could be a useful tool for predicting DLD, WLD, and ALD in light lambs, perhaps suffering from worse prediction properties when

  13. Estimates of genetic parameters for fatty acid compositions in the longissimus dorsi muscle of Hanwoo cattle.

    PubMed

    Bhuiyan, M S A; Lee, D H; Kim, H J; Lee, S H; Cho, S H; Yang, B S; Kim, S D

    2017-08-10

    We estimated the heritabilities (h 2) and genetic and phenotypic correlations among individual and groups of fatty acids, as well as their correlations with six important carcass and meat-quality traits in Korean Hanwoo cattle. Meat samples were collected from the longissimus dorsi muscles of 1000 Hanwoo steers that were 30-month-old (progeny of 85 proven Hanwoo bulls) to determine intramuscular fatty acid profiles. Phenotypic data on carcass weight (CWT), eye muscle area (EMA), back fat thickness (BFT), marbling score (MS), Warner-Bratzler shear force (WBSF) and intramuscular fat content (IMF) were also investigated using this half-sib population. Variance and covari.ance components were estimated using restricted maximum likelihood procedures under univariate and pairwise bivariate animal models. Oleic acid (C18:1n-9) was the most abundant fatty acid, accounting for 50.69% of all investigated fatty acids, followed by palmitic (C16:0; 27.33%) and stearic acid (C18:0; 10.96%). The contents of saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) were 41.64%, 56.24% and 2.10%, respectively, and the MUFA/SFA ratio, PUFA/SFA ratio, desaturation index (DI) and elongation index (EI) were 1.36, 0.05, 0.59 and 0.66, respectively. The h 2 estimates for individual fatty acids ranged from very low to high (0.03±0.14 to 0.63±0.14). The h 2 estimates for SFAs, MUFAs, PUFAs, DI and EI were 0.53±0.14, 0.49±0.14, 0.23±0.10, 0.51±0.13 and 0.53±0.13, respectively. The genetic and phenotypic correlations among individual fatty acids and fatty acid classes varied widely (-0.99 to 0.99). Notably, C18:1n-9 had favourable (negative) genetic correlations with two detrimental fatty acids, C14:0 (-0.76) and C16:0 (-0.92). Genetic correlations of individual and group fatty acids with CWT, EMA, BFT, MS, WBSF and IMF ranged from low to moderate (both positive and negative) with the exception of low-concentration PUFAs. Low or near

  14. Protein denaturation and water-protein interactions as affected by low temperature long time treatment of porcine longissimus dorsi.

    PubMed

    Christensen, Line; Bertram, Hanne C; Aaslyng, Margit D; Christensen, Mette

    2011-08-01

    The relationship between water-protein interactions and heat-induced protein denaturation in low temperature long time (LTLT) treated pork Longissimus dorsi was investigated by combining low-field NMR T₂ relaxometry with DSC measurements and measures of shrinkage of porcine Longissimus dorsi heated to 53 °C, 55 °C, 57 °C and 59 °C for either 3 or 20 h. Water within the myofibrils, measured by NMR T₂₁ relaxation times, was affected by both temperature and holding time during LTLT treatment between 53 °C and 59 °C. The changes in NMR T₂₁ relaxation times were associated with decreased fiber diameter and increased cooking loss, revealing a relationship between transverse shrinkage, water-protein interactions and cooking loss. DSC measurements revealed a concomitant decrease in ΔH(68 °C), which suggests impact of collagen denaturation on the retention of water within the meat during LTLT treatment. Furthermore, a decrease in ΔH(75 °C) suggested that prolonged cooking (20 h) resulted in actin denaturation leading to decreased T₂₁ relaxation times and higher cooking loss. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Internal mammary perforators as recipient vessels for deep inferior epigastric perforator and muscle-sparing free transverse rectus abdominis musculocutaneous flap breast reconstruction in an Asian population.

    PubMed

    Halim, Ahmad Sukari; Alwi, Akmal Azim

    2014-08-01

    The use of internal mammary perforators (IMPs) as recipient vessels in autologous free flap breast reconstruction has many additional benefits compared with the internal mammary or thoracodorsal vessels. Our goals were to analyze the characteristics of these vessels and to evaluate the reliability of using them in an Asian population. Thirty-five consecutive patients were prospectively studied between November 2000 and December 2010. Twelve patients underwent muscle-sparing-2 transverse rectus abdominis musculocutaneous flap, and 23 had deep inferior epigastric perforator flap reconstructions. Internal mammary perforator vessels were used in 29 patients (83%). Most (75%) of the vessels were located in the subcutaneous plane, and 85% were in the second and third intercostal spaces. There were significantly more usable IMP vessels in the immediate than in the delayed reconstructions (P = 0.049). All the flaps in the study were successful despite 1 requiring emergency re-exploration because of venous congestion. Most of the IMP vessels are small; however, they are still reliable and safe for use as recipient vessels in selected Asian patients. Most are located in the subcutaneous plane, which further facilitates dissection and also reduces recipient-site morbidity.

  16. Effect of soy lecithin on total cholesterol content, fatty acid composition and carcass characteristics in the Longissimus dorsi of Hanwoo steers (Korean native cattle).

    PubMed

    Li, Xiang Zi; Park, Byung Ki; Hong, Byuong Chon; Ahn, Jun Sang; Shin, Jong Suh

    2017-06-01

    This study aims to investigate the effect of soy lecithin on the total cholesterol content, the fatty acid composition and carcass characteristics in the Longissimus dorsi in Hanwoo steers. Hanwoo steers (24 head) were fed two diets: Control (CON) (concentrate + alcohol-fermented feed (AFF)) and soy lecithin treatment (CON + soy lecithin at 0.5% of the AFF). Soy lecithin treatment increased average daily gain, serum concentrations of triglyceride, total cholesterol and high-density lipoprotein-cholesterol in the blood. A lower cholesterol concentration was found in the Longissimus dorsi for the soy lecithin diet compared to the CON diet. With respect to the marbling score and quality grade of Longissimus dorsi, soy lecithin supplementation significantly increased the C20:5n3, C22:4 and polyunsaturated fatty acids contents compared to the CON diet. Soy lecithin supplementation would alter the total cholesterol content, polyunsaturated fatty acid profile and meat quality of Longissimus dorsi. © 2016 Japanese Society of Animal Science.

  17. Evaluation of Columbia, USMARC-Composite, Suffolk, and Texel rams as terminal sires in an extensive rangeland production system: VIII. Quality measures of lamb longissimus dorsi

    USDA-ARS?s Scientific Manuscript database

    Quality measures of lamb longissimus dorsi were evaluated in 514 crossbred wether lambs to assess sire breed differences. Wethers were produced over 3 yr from single-sire matings of 22 Columbia, 22 USMARC-Composite (Composite), 21 Suffolk, and 17 Texel rams to adult Rambouillet ewes. Lambs were rear...

  18. Radiation to the breast. Complications amenable to surgical treatment

    SciTech Connect

    Bostwick, J.; Stevenson, T.R.; Nahai, F.; Hester, T.R.; Coleman, J.J.; Jurkiewicz, M.J.

    1984-10-01

    Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. Classification: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.

  19. Radiation to the breast. Complications amenable to surgical treatment.

    PubMed Central

    Bostwick, J; Stevenson, T R; Nahai, F; Hester, T R; Coleman, J J; Jurkiewicz, M J

    1984-01-01

    Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. Classification: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits. Images FIG. 1. FIGS. 2A and B. FIGS. 3A-D. FIG. 4. FIGS. 5A and B. FIGS. 6A-D. FIGS. 7A and B. PMID:6486905

  20. [Effect of 30-day space flight and subsequent readaptation on the signaling processes in m. longissimus dorsi of mice].

    PubMed

    Mirzoev, T M; Vil'chinskaia, N A; Lomonosova, Iu N; Nemirovskaia, T L; Shenkman, B S

    2014-01-01

    Some steps of anabolic and catabolic signaling pathways were investigated in postural/tonic m. longissimus dorsi of mice following the 30-day orbital flight of biosatellite "Bion-M1" and 8-day recovery. Western blotting was used for determining insulin receptor substrate 1 (IRS-1) and AMR-activated protein kinase (AMPK) involved in reciprocal regulation of anabolic and catabolic pathways, as well as E3-ligase MURF-1, and elongation factor eEF2. Functioning of the IGF-1-dependent IRS-1 signaling pathway was activated in the recovery period only. Though the content of ubiquitinligase MURF-1 showed an increase after flight, on completion of the recovery period it did not exceed the pre-flight level unambiguously.

  1. Flavour development in pork. Influence of flavour precursor concentrations in longissimus dorsi from pigs with different raw meat qualities.

    PubMed

    Meinert, Lene; Tikk, Kaja; Tikk, Meelis; Brockhoff, Per B; Bredie, Wender L P; Bjergegaard, Charlotte; Aaslyng, Margit D

    2009-01-01

    Flavour development and overall eating quality of pan-fried pork chops of longissimus dorsi from eight different raw meat qualities aged for 4 and 15 days were assessed by a trained sensory panel. The raw meat qualities were obtained through combinations of strategic feeding/fasting (control vs. low glycogen concentration), slaughter live-weight (84kg vs. 110kg), and gender (female vs. castrate). The flavour development was investigated for possible correlation with the concentrations of selected individual flavour precursors present in the raw meat: monosaccharides, IMP and degradation products, fatty acids, lactate and thiamine. Differences in precursor concentrations between the raw meat qualities were observed with feeding/fasting and ageing as the main factors with the largest influence of all experimental factors. However, the concentrations of the precursors could not explain the differences in sensory perception of the pan-fried pork chops. Overall, the differences were small.

  2. Significance of the Lateral Thoracic Artery in Pectoralis Major Musculocutaneous Flap Reconstruction: Quantitative Assessment of Blood Circulation Using Indocyanine Green Angiography.

    PubMed

    Miyazaki, Hidetaka; Igari, Kimihiro; Kudo, Toshifumi; Iwai, Toshinori; Wada, Yoshitaka; Takahashi, Yasuhiro; Inoue, Yoshinori; Asamura, Shinichi

    2017-11-01

    Free tissue transfer is the preferred reconstruction option in most major head and neck reconstructions. The pectoralis major muscle musculocutaneous (PMMC) flap is commonly used in salvage of necrotic free flaps and is the first choice for patients who are not candidates for free flaps. The lateral thoracic artery (LTA), which is thought to contribute to blood perfusion of the inferior and lateral mammary area, is not preserved in a conventionally harvested PMMC flap. With regard to blood supply, it has been suggested that the LTA should be preserved, in addition to the pectoral branch of the thoracoacromial artery, when a skin island is designed in the lower chest to attain a pedicle length sufficient for head and neck reconstruction. However, an effect on hemodynamic improvement using the LTA has not been shown quantitatively. In this study, we examined 8 patients with oral cancer who underwent reconstruction procedures with a bipedicle PMMC flap that included the LTA, in addition to the thoracoacromial artery. Intraoperative indocyanine green angiography was performed to examine circulation to the PMMC flap with or without LTA clamping after harvesting. After image processing, data were analyzed using a new quantitative perfusion assessment system with parameters that we recently established for assessment of peripheral arterial disease of the lower limbs. All patients had good clinical courses with whole-flap survival, no vascular insufficiency of the skin island, and no fistula formation. Intraoperative indocyanine green angiography showed an increased inflow rate into the skin island in an LTA-declamped condition in all cases, implying that the preserved LTA increased the blood supply to skin islands in the pectoralis major muscle. We conclude that preserving the LTA in a PMMC flap can increase blood perfusion and stabilize the vascularity of the flap, making the reconstruction more effective and reliable than with use of a conventionally harvested flap

  3. Comparative genomic approach reveals novel conserved microRNAs in Inner Mongolia cashmere goat skin and longissimus dorsi.

    PubMed

    Su, Rui; Fu, Shaoyin; Zhang, Yanjun; Wang, Ruijun; Zhou, Yanhong; Li, Jinquan; Zhang, Wenguang

    2015-05-01

    MicroRNA (miRNA) is a large class of non-coding RNA which usually acts a fine-tuned regulation in repressing gene expression on transcriptional and post-transcriptional level during ontogenetic development, metabolism, and occurrence of disease. Due to the lateness of goat genome investigation, registered goat microRNAs are little known and the function of it is poorly understood. In this study, we identified 5 novel miRNAs express in cashmere goat skin and longissimus dorsi using comparative genomic approach combined with expression profile analysis. Further qPCR and sequencing validation demonstrated that the novel miRNAs we identified expressed in goat skin and longissimus dorsi, three of them with the highest expression in February and two in October, indicating these novel microRNAs were involved in growth and cessation of goat hair production. Subsequently, potential target genes were explored via base-pairing with complementary sequences miRNA/mRNA interaction searching. WDR12 and CSNK1A1 involved in Notch/Wnt signal transduction pathway were finally identified. Collectively, the approach of comparative genomics combining expression profile analysis is a powerful tool to identify novel miRNA in goat and the 5 identified novel miRNAs(chi-miR-2284n, chi-miR-421*, chi-miR-421, chi-miR-1839 and chi-miR-374; Accession number: JQ002550-JQ002554) play a essential role in goat hair production of cashmere goat, both in entering growth and cessation phase. This study is also a meaningful complement to the present goat miRNA database for further understanding function of miRNAs in regulation of goat cashmere production.

  4. Distinctive Genes Determine Different Intramuscular Fat and Muscle Fiber Ratios of the longissimus dorsi Muscles in Jinhua and Landrace Pigs

    PubMed Central

    Yuan, Zhangqin; Lo, Li Jan; Chen, Jun; Wang, Yizhen; Peng, Jinrong

    2013-01-01

    Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF). Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase) are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1) are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90), we identified a novel gene porcine FLJ36031 (pFLJ), which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF. PMID:23301040

  5. Distinctive genes determine different intramuscular fat and muscle fiber ratios of the longissimus dorsi muscles in Jinhua and landrace pigs.

    PubMed

    Wu, Ting; Zhang, Zhenhai; Yuan, Zhangqin; Lo, Li Jan; Chen, Jun; Wang, Yizhen; Peng, Jinrong

    2013-01-01

    Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF). Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase) are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1) are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90), we identified a novel gene porcine FLJ36031 (pFLJ), which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF.

  6. Discovery of porcine miRNA-196a/b may influence porcine adipogenesis in longissimus dorsi muscle by miRNA sequencing.

    PubMed

    Liu, Linqing; Qian, Kun; Wang, Chonglong

    2017-04-01

    Intramuscular fat (IMF) is one of the fat traits that has economic importance in the pork industry. Longissimus dorsi muscle contains IMF and is suitable for studying adipogenesis. To discover further potential regulatory miRNAs that may influence adipogenesis, we analyzed miRNA in the longissimus dorsi muscle of Yorkshire (YY, lean-type) and Chinese Wannanhua (WH, fatty) pigs using miRNA sequencing (miRNA-seq). From this dataset, we identified 598 unique miRNAs comprising 325 pre-miRNAs and 273 novel pre-miRNAs through comparison with known miRNAs in miRBase version 21. We found 42 miRNAs including nine up- and 33 down-regulated between the YY and WH pigs. Moreover, we found two miRNAs, miR-196a/b (miR-196a, miR-196b-5p), that had the highest level of expression in WH pigs, and miR-196a/b may influence porcine adipogenesis in longissimus dorsi muscle through an adipocytokine signaling pathway.

  7. High-affinity glutamate transporter and glutamine synthetase content in longissimus dorsi and adipose tissues of growing Angus steers differs among suckling, weanling, backgrounding, and finishing production stages.

    PubMed

    Matthews, J C; Huang, J; Rentfrow, G

    2016-03-01

    Skeletal muscle and adipose tissues play important roles in maintaining whole-body Glu and N homeostasis by the uptake of Glu and release of Gln. To test the hypothesis that expression of high-affinity Glu transporters (GLAST1, EAAT4, EAAC1, GLT-1) and glutamine synthetase (GS) would increase in longissimus dorsi and adipose tissue of newborn Angus steers randomly assigned ( = 6) to develop through suckling (S; 32 d) and/or weanling (W; 184 d), backgrounding (B; 248 d), and finishing (F; 423 d) production stages. Carcass quality was determined at slaughter to verify shifts in adipose and lean deposition with development. Expression of mRNA (RT-PCR/Southern) and relative protein abundance (Western analysis) were determined in tissue homogenates isolated from longissimus dorsi, and kidney and subcutaneous adipose. The effect of production stage or tissue type on carcass and protein abundance was assessed by 1-way ANOVA using the GLM procedure of SAS, and Fisher's protected LSD procedure was used to separate data means. Neither GLAST1 nor EAAT4 mRNA or protein was detected. EAAC1, GLT-1, and GS mRNA were identified in all tissues, but GLT-1 and GS protein were not detected in kidney or subcutaneous adipose, and GS protein was not detected in longissimus dorsi. The EAAC1 content of subcutaneous ( = 0.06) and kidney ( = 0.02) adipose was 2 times greater in B and F than W steers, whereas GS was 5 times greater ( < 0.07) in B than F steers (B = W > F). For longissimus dorsi, EAAC1 ( < 0.01) and GLT-1 ( < 0.04) content decreased with development (S > W > B = F, S = W > B = F, respectively). Within F steers, EAAC1 and GLT-1 mRNA was expressed by subcutaneous, kidney, omental, mesenchymal, and intramuscular adipose tissues, whereas GS mRNA was expressed by all except for intramuscular. Only EAAC1 protein was detected in any adipose tissue, with EAAC1 content being 104% and 112% greater ( < 0.01) in intramuscular than in kidney or subcutaneous adipose, respectively, and not

  8. Physical and chemical characteristics of the longissimus dorsi from swine reared in climate-controlled and uncontrolled environments

    NASA Astrophysics Data System (ADS)

    de Mello, Juliana Lolli Malagoli; Berton, Mariana Piatto; de Cassia Dourado, Rita; Giampietro-Ganeco, Aline; de Souza, Rodrigo Alves; Ferrari, Fábio Borba; de Souza, Pedro Alves; Borba, Hirasilva

    2017-04-01

    The aim of this study was to evaluate the effect of ambient temperature on the physical and chemical characteristics of the longissimus dorsi muscle by comparing the quality of meat from pigs reared in a controlled and in an uncontrolled environment, the latter provided with a shallow pool. Twenty castrated male pigs of the Topigs line were randomly allotted to two treatments: a controlled environment, with constant temperature (22 °C) and relative humidity (70%); and an uncontrolled environment in a conventional shed for rearing pigs equipped with a shallow pool, where pigs were subject to climatic variations. Meat from pigs kept in the controlled environment showed a greater capacity to retain intracellular water, higher tenderness, and lower cholesterol levels than meat from pigs reared in the uncontrolled environment, but displayed higher lipid oxidation and a lower concentration of DHA. Treatments had no effect on color, pH, chemical composition, or fatty acid profile (except DHA concentration). Rearing pigs in sheds equipped with a shallow pool minimizes the effects of environmental heat on meat quality, allowing the production of high-quality meat in warm climate regions without expensive investments. Animals reared in an uncontrolled environment equipped with a shallow pool are able to produce meat with characteristics within the quality standards and with similar quality to that of meat from animals raised in controlled environment.

  9. Dietary leucine supplementation alters energy metabolism and induces slow-to-fast transitions in longissimus dorsi muscle of weanling piglets.

    PubMed

    Fan, Qiwen; Long, Baisheng; Yan, Guokai; Wang, Zhichang; Shi, Min; Bao, Xiaoyu; Hu, Jun; Li, Xiuzhi; Chen, Changqing; Zheng, Zilong; Yan, Xianghua

    2017-05-01

    Leucine plays an important role in promoting muscle protein synthesis and muscle remodelling. However, what percentage of leucine is appropriate in creep feed and what proteome profile alterations are caused by dietary leucine in the skeletal muscle of piglets remain elusive. In this case, we applied isobaric tags for relative and absolute quantitation to analyse the proteome profile of the longissimus dorsi muscles of weanling piglets fed a normal leucine diet (NL; 1·66 % leucine) and a high-leucine diet (HL; 2·1 % leucine). We identified 157 differentially expressed proteins between these two groups. Bioinformatics analysis of these proteins exhibited the suppression of oxidative phosphorylation and fatty acid β-oxidation, as well as the activation of glycolysis, in the HL group. For further confirmation, we identified that SDHB, ATP5F1, ACADM and HADHB were significantly down-regulated (P<0·01, except ATP5F1, P<0·05), whereas the glycolytic enzyme pyruvate kinase was significantly up-regulated (P<0·05) in the HL group. We also show that enhanced muscle protein synthesis and the transition from slow-to-fast fibres are altered by leucine. Together, these results indicate that leucine may alter energy metabolism and promote slow-to-fast transitions in the skeletal muscle of weanling piglets.

  10. Characterizing differential post-stroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation.

    PubMed

    Palmer, Jacqueline Ann; Zarzycki, Ryan; Morton, Susanne M; Kesar, Trisha M; Binder-Macleod, Stuart A

    2017-01-11

    Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery post-stroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, post-stroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, while conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to post-stroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor post-stroke walking recovery and in neurologically-intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared to dorsiflexor muscles in individuals with poor post-stroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles when compared to the neurologically-intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor versus dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery.

  11. Dietary influence on the m. longissimus dorsi fatty acid composition of lambs in relation to protein source.

    PubMed

    Turner, T D; Karlsson, L; Mapiye, C; Rolland, D C; Martinsson, K; Dugan, M E R

    2012-08-01

    Dietary lipid effect, as a consequence of protein supplement, on lamb m. longissimus dorsi fatty acid composition was investigated, with emphasis on biohydrogenation intermediates. Crossbred lambs (White Swedish Landrace × Texel) were fed a barley-based diet without (CON) or with protein supplements including peas (PEA), rapeseed cake (RC) or hempseed cake (HC). The HC diet resulted in the highest muscle 22:6n-3 proportion, with the RC diet being similar (P<0.05). Protein supplement did not affect the c9,t11 conjugated linoleic acid (CLA) proportion, however the HC diet increased some minor CLA isomers, including t10,c12 CLA (P<0.05). The t10-18:1 and total trans-18:1 were lowest for the RC diet (P<0.05), likely relating to rumen conditions and precursor availability. The saturated, monounsaturated and branched-chain fatty acids were largely unaffected by protein supplement. In conclusion, feeding the RC diet lowered the t10-18:1 and total trans-18:1 in meat, and modestly increased 22:6n-3 content. The direction of these changes would be beneficial, making the RC diet the preferred protein supplement; however the magnitude of the changes in the present experiment may not be sufficient to have an impact on human health.

  12. New data on the total lipid, cholesterol and fatty acid composition of raw and grilled beef longissimus dorsi.

    PubMed

    Bragagnolo, Neura; Rodriguez-Amaya, Délia B

    2003-09-01

    Simultaneous analyses of total lipids, cholesterol and fatty acids were carried out on raw and grilled beef longissimus dorsi trimmed of external fat. Cholesterol was determined by high performance liquid chromatography and the fatty acids by gas chromatography. Mean total lipid (g/100 g) ranged from 2.1 to 2.6 for raw beef and 3.5 to 4.0 for grilled beef steaks. Cholesterol levels (mg/100 g) ranged from 40 to 43 for raw beef and 67 to 70 for grilled beef steaks. The main intramuscular fatty acids of the raw and grilled meat were 14:0, 16:0, 16:1n7, 18:0, 18:1n9, 18:1n7 and 18:2n6. Grilled lean beef steaks had significantly higher contents of the principal fatty acids and most of the minor fatty acids. The higher values for the three components in the grilled meat were due to loss of moisture during grilling. There was no significant difference between the apparent and true retentions values, both indicating no significant loss or degradation of total lipids, cholesterol and fatty acids during grilling.

  13. Impact of RN genotype and ageing time on colour characteristics of the pork muscles longissimus dorsi and semimembranosus.

    PubMed

    Lindahl, Gunilla; Enfält, Ann-Charlotte; Andersen, Henrik J; Lundström, Kerstin

    2006-12-01

    The effect of RN genotype on pH decline, ultimate pH, pigment content, blooming and colour stability during 6 days of display at 5°C was studied in two pig muscles, M. longissimus dorsi (LD) and M. semimembranosus (SM), and furthermore the effect of anaerobic storage time (2 days vs. 9 days of ageing) on the same parameters was examined. The postmortem pH decline was faster and the ultimate pH lower in LD and SM of the RN(-) genotype compared with corresponding muscles from the rn(+) genotype. Pork of the RN(-) genotype was initially lighter and more red and yellow than pork of the rn(+) genotype due to a higher degree of blooming, which might be explained by the faster pH decline and/or lower ultimate pH. The level of oxymyoglobin (MbO(2)) was decisive for the redness of both muscles during display in air despite a higher presence of metmyoglobin (MetMb). Pork of the RN(-) genotype was thus redder than that of the rn(+) genotype throughout display in air despite higher oxidation to MetMb. Ageing for 9 days in chill improved the blooming potential in pork of both genotypes compared with 2 days of ageing, resulting in superior meat colour. However, only in pork from the RN(-) genotype, the colour was not negatively affected by ageing time upon display in air.

  14. Composition, sensory and shelf life stability analyses of Longissimus dorsi muscle from steers reared under organic and conventional production systems.

    PubMed

    Walshe, B E; Sheehan, E M; Delahunty, C M; Morrissey, P A; Kerry, J P

    2006-06-01

    In recent years the demand for organically grown food has increased. In this study, organic (O, n=6) and conventionally (C, n=6) reared steers aged between 18 and 24 months were slaughtered during the month of September 2002. Four days post-slaughter, the Longissimus dorsi (LD) muscle was excised from the left side of each carcass. All muscles were vacuum packed and aged in a chill for a further seven days. Steaks were cut from each sample, and from these, lean meat was removed, blended and compositional analysis was carried out. O samples were significantly higher (P>0.05) in fat content and therefore were significantly (P>0.05) lower in moisture content than C samples. No significant differences were observed between C and O samples for protein, ash, β-carotene, α-tocopherol or retinol. There was also no significant difference in fatty acid content between C and O samples. Colour stability and fat oxidative stability of samples were also measured, while stored under retail conditions. Samples were packed using both modified atmosphere packaging (MAP) and by overwrapping with cling film. MAP C samples had the best colour stability while overwrapped C samples had the best lipid stability. Therefore, colour and lipid stability of beef samples were influenced by sample composition and packaging format used, which resulted in C samples outperforming O samples with respect to shelf life stability.

  15. Effect of Dietary Supplementation with Processed Sulfur on Meat Quality and Oxidative Stability in Longissimus dorsi of Pigs

    PubMed Central

    Noh, Ha-Young; Kim, Gyeom-Heon; Kim, Soo-Ki

    2015-01-01

    The effects of dietary supplementation of processed sulfur in pigs according to the level provided during the fattening phase were examined. The pigs were divided into three groups: control (CON), non-sulfur fed pigs; T1, 0.1% processed sulfur fed pigs; T2, 0.3% processed sulfur fed pigs. Physicochemical and sensory properties, as well as meat quality and oxidative stability of the Longissimus dorsi muscle were investigated. The feeding of processed sulfur did not affect moisture and protein contents (p>0.05). However, the crude fat content of T2 was significantly decreased compared to CON (p<0.05), while the pH value of T2 was significantly higher than those of both CON and T1 (p<0.05). Cooking loss and expressible drip of T2 were also significantly lower than that of CON (p<0.05). The redness of meat from T1 was significantly higher than both CON and T2 (p<0.01). During storage, lipid oxidation of the meat from sulfur fed pigs (T1 and T2) was inhibited compared to CON. Examination of omega-3 polyunsaturated fatty acids revealed T2 to have significantly higher content than CON (p<0.05). In the sensory test, the juiciness and overall acceptability of T2 recorded higher scores than CON. This study demonstrated that meat from 0.3% processed sulfur fed pigs had improved nutrition and quality, with extended shelf-life. PMID:26761847

  16. Influence of Restricted Grazing Time Systems on Productive Performance and Fatty Acid Composition of Longissimus dorsi in Growing Lambs

    PubMed Central

    Wang, Zhenzhen; Chen, Yong; Luo, Hailing; Liu, Xueliang; Liu, Kun

    2015-01-01

    Fifty 3-month-old male Tan lambs (similar in body weight) were divided into 5 groups to investigate the effects of different restricted pasture grazing times and indoor supplementation on the productive performances and fatty acid composition of the intramuscular fat in growing lambs. The lambs grazed for different periods of time (12 h/d, 8 h/d, 4 h/d, 2 h/d, and 0 h) and received various amounts of supplementary feedings during the 120-day trial. Pasture dry matter intake (DMI), total DMI, average daily gains and the live body weights of the lambs were measured during the experiment. The animals were slaughtered at the end of the study, their carcass traits were measured, and their longissimus dorsi muscles were sampled to analyze the intramuscular fat (IMF) content and fatty acid profiles. The results indicated that the different durations of grazing and supplementary feedings affected the animal performances and the composition of fatty acids. Grazing for 8 h/d or 2 h/d with the corresponding supplementary concentrate resulted in lambs with higher body weights, carcass weights and IMF contents. Lambs with longer grazing times and less concentrate accumulated more healthy fatty acids such as conjugated linoleic acid and n-3 polyunsaturated fatty acid and had higher n-3/n-6 ratios. Overall, a grazing allowance of 8 h/d and the corresponding concentrate was recommended to maintain a high quantity and quality of lamb meat. PMID:26104518

  17. Integrative transcriptomics and proteomics analysis of longissimus dorsi muscles of Canadian double-muscled Large White pigs.

    PubMed

    Liu, Shuqin; Han, Wenpeng; Jiang, Shunyan; Zhao, Chunjiang; Wu, Changxin

    2016-02-10

    Canadian double-muscled Large White pigs are characterized by notable muscle mass, showing high daily gain and lean rate and good meat quality. In order to identify the major genes or proteins involved in muscle hyperplasia and hypertrophy, three pairs of full-sib pigs with extreme muscle mass difference from Canadian Large White were selected as experimental animals at 3 months age. The phenotypic differences of longissimus dorsi muscles (LD) were investigated with microarray and proteomics (2-DE, MALDI-TOF-MS), and results were verified by real-time PCR and western bolting respectively. The gene expressing profiling identified 57 and 260 and 147 differently expressed genes (DEGs) from the three pairs respectively with Bayesian statistics and significant analysis of microarrays (SAM) (p<0.05, q<0.05, fold>2). From the network of these DEGs, some major genes were displayed, such as EGF, PPARG, FN1, SERPINE1, MYC, JUN, involved in Wnt, MAPK and TGF-β signal pathway respectively, which mainly participated in cell differentiation and proliferation. In parallel, proteomics analyses revealed 50 differently expressed protein (DEP) spots with mass spectrum, and 33 spots of them were found annotated, which took part in energy metabolism and the structure and contraction of muscle fiber. In brief, our integrated study provides a good foundation for the further study on the genetic mechanism of the double muscle traits in pigs.

  18. Reconstruction of Lateral Skull Base Defects: A Comparison of the Submental Flap to Free and Regional Flaps.

    PubMed

    Howard, Brittany E; Nagel, Thomas H; Barrs, David M; Donald, Carrlene B; Hayden, Richard E

    2016-06-01

    To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects. Case series with chart review. Tertiary academic referral center. Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014. Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P = .00817) and duration of hospitalization (4.9 vs 9.8 days; P = .02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P < .00001) and free flaps (mean, 1.6; P < .00001). There was 100% flap survival. The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  19. Identification and Expression Profiling of miRNAome in Goat longissimus dorsi Muscle from Prenatal Stages to a Neonatal Stage.

    PubMed

    Guo, Jiazhong; Zhao, Wei; Zhan, Siyuan; Li, Li; Zhong, Tao; Wang, Linjie; Dong, Yao; Zhang, Hongping

    2016-01-01

    Skeletal muscle development is a complex biological process regulated by numerous genes and non-coding RNAs, such as microRNAs (miRNAs). In the current study, we made use of the deep sequencing data from Jianzhou Da'er goat longissimus dorsi sampled on days 45, 60, and 105 of gestation, as well as day three after birth to identify miRNAs that regulate goat skeletal myogenesis, and examine their temporal expression profiles. A total of 410 known goat miRNAs, 752 miRNA homologs and 88 novel miRNAs were identified across four stages. Besides three myomiRs, the abundance of 17 miRNAs, including chi-miR-424, chi-miR-542-3p and chi-miR-136-5p was more than 10,000 reads per million mapped reads (RPM), on average. Furthermore, 50 miRNAs with more than 100 RPM clustered at the imprinted DLK1-DIO3 locus on chromosome 21 and showed similar expression patterns, indicating that these miRNAs played important roles in skeletal myogenesis of goats. Based on pairwise comparisons, 221 differentially expressed (DE), known miRNAs were identified across four stages. GO and KEGG analyses of the genes targeted by the DE miRNAs revealed the significantly enriched processes and pathways to be consistent with temporal changes of skeletal muscle development across all sampled stages. However, follow-up experimental studies were required to explore functions of these miRNAs and targets underlying skeletal myogenesis.

  20. Early Post Mortem pH decrease in porcine M. longissimus dorsi of PSE, Normal and DFD quality.

    PubMed

    Enfält, A C; Lundström, K; Engstrand, U

    1993-01-01

    The purpose of this investigation was to compare the muscle pH at exsanguination and the rate of pH changes in porcine M. longissimus dorsi (LD) of normal, DFD (Dark, Firm, Dry) and PSE (Pale, Soft, Exudative) quality. The pH was continuously measured in the LD in 116 carcasses during the first 50 min post mortem. Calculations were made both on measured pH-values and on pH-values transformed to hydrogen ion concentrations. A regression of pH or hydrogen ion concentration on time was made for each animal. These individual regressions were then combined, using a multivariate analysis to estimate regression curves for each meat quality class. The two methods for expressing pH gave somewhat different results. The relationship between the hydrogen ion concentration and time was found to be linear for normal and DFD muscles and quadratic for PSE muscles. As a consequence of the mathematical properties of pH, the relationship between pH and time was found to be quadratic for the normal and DFD qualities, and linear for the PSE quality. For both methods of calculations the slopes for the regression curves were significantly different between PSE and the other two quality classes with both calculating methods, while the slopes did not differ between normal and DFD muscle qualities. The intercepts of the regression curves differed significantly between PSE and the other two quality classes only when the calculations were made on measured pH-values without transformation. A temporary increase in pH was seen in some normal and PSE carcasses during the measured time period. Development of muscles with PSE characteristics thus seems to be initiated by a combination of a lower muscle-pH already at exsanguination and a faster pH decrease. It is also of importance to consider the special mathematical properties of the pH-value. Copyright © 1993. Published by Elsevier Ltd.

  1. Identification and Expression Profiling of miRNAome in Goat longissimus dorsi Muscle from Prenatal Stages to a Neonatal Stage

    PubMed Central

    Guo, Jiazhong; Zhao, Wei; Zhan, Siyuan; Li, Li; Zhong, Tao; Wang, Linjie; Dong, Yao; Zhang, Hongping

    2016-01-01

    Skeletal muscle development is a complex biological process regulated by numerous genes and non-coding RNAs, such as microRNAs (miRNAs). In the current study, we made use of the deep sequencing data from Jianzhou Da’er goat longissimus dorsi sampled on days 45, 60, and 105 of gestation, as well as day three after birth to identify miRNAs that regulate goat skeletal myogenesis, and examine their temporal expression profiles. A total of 410 known goat miRNAs, 752 miRNA homologs and 88 novel miRNAs were identified across four stages. Besides three myomiRs, the abundance of 17 miRNAs, including chi-miR-424, chi-miR-542-3p and chi-miR-136-5p was more than 10,000 reads per million mapped reads (RPM), on average. Furthermore, 50 miRNAs with more than 100 RPM clustered at the imprinted DLK1–DIO3 locus on chromosome 21 and showed similar expression patterns, indicating that these miRNAs played important roles in skeletal myogenesis of goats. Based on pairwise comparisons, 221 differentially expressed (DE), known miRNAs were identified across four stages. GO and KEGG analyses of the genes targeted by the DE miRNAs revealed the significantly enriched processes and pathways to be consistent with temporal changes of skeletal muscle development across all sampled stages. However, follow-up experimental studies were required to explore functions of these miRNAs and targets underlying skeletal myogenesis. PMID:27798673

  2. Transcriptome analysis reveals that constant heat stress modifies the metabolism and structure of the porcine longissimus dorsi skeletal muscle.

    PubMed

    Hao, Yue; Feng, Yuejin; Yang, Peige; Cui, Yanjun; Liu, Jiru; Yang, Chunhe; Gu, Xianhong

    2016-12-01

    Exposure to high ambient temperatures is detrimental to pig rearing and porcine meat quality. Deep molecular sequencing allows for genomic characterization of porcine skeletal muscles and helps understand how the genomic landscape may impact meat quality. To this end, we performed mRNA-seq to molecularly dissect the impact of heat stress on porcine skeletal muscles, longissimus dorsi. Sixteen castrated, male DLY pigs [which are crossbreeds between Duroc (D) boars and Landrace (L) × Yorkshire (Y) sows, 79.0 ± 1.5 kg BW] were evenly split into two groups that were subjected to either control (CON) (22 °C; 55 % humidity) or constant heat stress (H30; 30 °C; 55 % humidity) conditions for 21 days. Seventy-eight genes were found to be differentially expressed, of which 37 were up-regulated and 41 were down-regulated owing to constant heat stress. We predicted 5247 unknown genes and 6108 novel transcribed units attributed to alternative splicing (AS) events in the skeletal muscle. Furthermore, 30,761 and 31,360 AS events were observed in the CON and H30 RNA-seq libraries, respectively. The differentially expressed genes in the porcine skeletal muscles were involved in glycolysis, lactate metabolism, lipid metabolism, cellular defense, and stress responses. Additionally, the expression levels of these genes were associated with variations in meat quality between the CON and H30 groups, indicating that heat stress modulated genes crucial to skeletal muscle development and metabolism. Our transcriptomic analysis provides valuable information for understanding the molecular mechanisms governing porcine skeletal muscle development. Such insights may lead to innovative strategies to improve meat quality of pigs under heat stress.

  3. Transcript profiles in longissimus dorsi muscle and subcutaneous adipose tissue: a comparison of pigs with different postweaning growth rates.

    PubMed

    Pilcher, C M; Jones, C K; Schroyen, M; Severin, A J; Patience, J F; Tuggle, C K; Koltes, J E

    2015-05-01

    Although most pigs recover rapidly from stresses associated with the transition of weaning, a portion of the population lags behind their contemporaries in growth performance. The underlying biological and molecular mechanisms involved in postweaning differences in growth performance are poorly understood. The objective of this experiment was to use transcriptional profiling of skeletal muscle and adipose tissue to develop a better understanding of the metabolic basis for poor weaned-pig transition. A total of 1,054 pigs was reared in commercial conditions and weighed at birth, weaning, and 3 wk postweaning. Transition ADG (tADG) was calculated as the ADG for the 3-wk period postweaning. Nine pigs from both the lowest 10th percentile (low tADG) and the 60th to 70th percentile (high tADG) were harvested at 3 wk postweaning. Differential expression analysis was conducted in longissimus dorsi muscle (LM) and subcutaneous adipose tissue using RNA-Seq methodology. In LM, 768 transcripts were differentially expressed (DE), 327 with higher expression in low tADG and 441 with higher expression in high tADG pigs (q < 0.10). Expression patterns measured in LM by RNA-Seq were verified in 30 of 32 transcripts using quantitative PCR. No DE transcripts were identified in adipose tissue. To identify biological functions potentially underlying the effects of tADG on skeletal muscle metabolism and physiology, functional annotation analysis of the DE transcripts was conducted using DAVID and Pathway Studio analytic tools. The group of DE genes with lower expression in LM of low tADG pigs was enriched in genes with functions related to muscle contraction, glucose metabolism, cytoskeleton organization, muscle development, and response to hormone stimulus (enrichment score > 1.3). The list of DE genes with higher expression in low tADG LM was enriched in genes with functions related to protein catabolism (enrichment score > 1.3). Analysis of known gene-gene interactions identified

  4. Developmental changes in the expression of the GLUT2 and GLUT4 genes in the longissimus dorsi muscle of Yorkshire and Tibetan pigs.

    PubMed

    Liang, Y; Yang, X M; Gu, Y R; Tao, X; Zhong, Z Z; Gong, J J; Chen, X H; Lv, X B

    2015-02-13

    Glucose transporter proteins 2 and 4 (GLUT2 and GLUT4) play important roles in glucose transport and energy metabolism. Changes in the levels of GLUT2 and GLUT4 mRNA were measured in longissimus dorsi muscle from the lean Yorkshire and fat Tibetan pig breeds at six different time points (1, 2, 3, 4, 5, and 6 months) with quantitative real-time polymerase chain reactions. The results showed that GLUT2 and GLUT4 mRNA were abundantly expressed in the longissimus dorsi muscle and that the developmental expression patterns were similar in both breeds. Tibetan pigs exhibited higher intramuscular fat and GLUT2 mRNA levels, while Yorkshire pigs exhibited a higher myofiber cross-sectional area (CSA) and GLUT4 mRNA levels. Furthermore, the changes in the GLUT4 mRNA levels were strongly and positively correlated with the CSA over a period of six months. These results exhibit time- and breed-specific expression patterns of GLUT2 and GLUT4, which highlight their potential as candidate genes for assessing adipose deposition and muscle development in pigs. These differences in the expression of GLUT family genes may also have indications for meat quality.

  5. Genetic parameters of carcass and meat quality traits in different muscles (longissimus dorsi and semimembranosus) of Hanwoo (Korean cattle).

    PubMed

    Bhuiyan, M S A; Kim, H J; Lee, D H; Lee, S H; Cho, S H; Yang, B S; Kim, S D; Lee, S H

    2017-08-01

    We estimated heritability () and genetic and phenotypic correlations for carcass and meat quality traits of longissimus dorsi (LD) and semimembranosus (SM) muscles in 30-mo-old Hanwoo steers. Variance and covariance components were estimated using REML procedures under univariate and bivariate models. The mean carcass weight (CWT), eye muscle area (EMA), back fat thickness (BFT), and marbling score (MS) were 428.20 ± 46.30 kg, 87.38 ± 8.54 cm2, 13.00 ± 5.14 mm, and 5.21 ± 1.56, respectively. The mean CIE reflectance of meat lightness (L*), redness (a*), and yellowness (b*) were 40.01 ± 2.73, 22.37 ± 2.18, and 10.35 ± 1.46, respectively, in LD muscles and 36.33 ± 2.44, 22.91 ± 2.43, and 10.25 ± 1.65, respectively, in SM muscles. The mean Warner-Bratzler shear force (WBSF), intramuscular fat content (IMF), water-holding capacity (WHC), and protein and ash content in LD and SM muscles were 3.84 ± 0.96 and 6.52 ± 1.21 kg, 15.91 ± 4.39 and 5.10 ± 1.94%, 62.07 ± 3.38 and 71.61 ± 2.06%, 20.01 ± 1.39 and 21.34 ± 0.89%, and 0.80 ± 0.10 and 0.93 ± 0.07, respectively. The estimates of CWT, EMA, BFT, and MS were 0.51 ± 0.13, 0.45 ± 0.13, 0.29 ± 0.09, and 0.22 ± 0.08, respectively. The estimates were moderate for meat quality traits and were 0.37 ± 0.12, 0.40 ± 0.12, 0.33 ± 0.10, 0.33 ± 0.10, 0.30 ± 0.11, and 0.24 ± 0.09 for L*, WBSF, IMF, WHC, and protein and ash content, respectively, in LD muscle; estimates from SM muscle were comparatively low (0.08 ± 0.06 to 0.25 ± 0.09). Estimates of for a* and b* were also low (0.08 ± 0.06 to 0.13 ± 0.07). Carcass weight had a moderate, positive genetic correlation with EMA (0.60 ± 0.13) and a weak correlation with MS and BFT. The genetic correlations among the 3 colorimeter variants were strong and positive within and between muscles. Intramuscular fat content had moderate to strong and negative genetic correlations with WBSF (-0.49 ± 0.18), WHC (-0.99 ± 0.01), and protein (-0.93 ± 0.04) and ash

  6. Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap

    PubMed Central

    Jamjoom, Hytham; Alnoman, Hatem

    2016-01-01

    Summary: The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable. PMID:28293496

  7. Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap.

    PubMed

    Jamjoom, Hytham; Alnoman, Hatem; Almadani, Yasser

    2016-12-01

    The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable.

  8. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area

    PubMed Central

    Yoon, Sehoon; Lázaro, Hudson Alex

    2016-01-01

    A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery. PMID:27896193

  9. Primary osteogenic sarcoma of the breast

    PubMed Central

    Ogundiran, Temidayo O; Ademola, Samuel A; Oluwatosin, Odunayo M; Akang, Effiong E; Adebamowo, Clement A

    2006-01-01

    Background Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast. Case presentation A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy. Conclusion A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria PMID:17156481

  10. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area.

    PubMed

    Yoon, Sehoon; Jeong, Euicheol; Lázaro, Hudson Alex

    2016-11-01

    A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

  11. Divided and Sliding Superficial Temporal Artery Flap for Primary Donor-site Closure

    PubMed Central

    Sugio, Yuta; Seike, Shien; Hosokawa, Ko

    2016-01-01

    Summary: Superficial temporal artery (STA) flaps are often used for reconstruction of hair-bearing areas. However, primary closure of the donor site is not easy when the size of the necessary skin island is relatively large. In such cases, skin grafts are needed at the donor site, resulting in baldness. We have solved this issue by applying the divided and sliding flap technique, which was first reported for primary donor-site closure of a latissimus dorsi musculocutaneous flap. We applied this technique to the hair-bearing STA flap, where primary donor-site closure is extremely beneficial for preventing baldness consequent to skin grafting. The STA flap was divided into 3, and creation of large flap was possible. Therefore, we concluded that the divided and sliding STA flap could at least partially solve the donor-site problem. Although further investigation is necessary to validate the maximum possible flap size, this technique may be applicable to at least small defects that are common after skin cancer ablation or trauma. PMID:27975020

  12. Immediate chest wall reconstruction during pregnancy: surgical management after extended surgical resection due to primary sarcoma of the breast.

    PubMed

    Arruda, Eduardo Gustavo; Munhoz, Alexandre Mendonça; Montag, Eduardo; Filassi, José Roberto; Gemperli, Rolf

    2014-01-01

    Breast sarcoma during pregnancy is an extremely rare event and represents a complex problem because of a more advanced stage at presentation. This report presents the first case of a 24-year-old woman with a gestational age of 20 weeks with a fast growing tumour in her left breast (29 × 19 × 15 cm) and infiltrating the skin/pectoralis muscles. Radical mastectomy was performed with a gestational age of 22 weeks and a different design was planned for the latissimus dorsi musculocutaneous flap (LDMF) with primary closure in the V-Y pattern. Satisfactory chest wall coverage and contour were achieved. Final histopathological findings allowed a diagnosis of undifferentiated sarcoma. With a gestational age of 37 weeks, a healthy infant was delivered by means of a caesarean section. The patient is currently in the second postoperative year and no recurrence has been observed. Management of a large breast sarcoma in a pregnant patient presents unique challenges in consideration of the potential risks to the foetus and the possible maternal benefit. The results of this study demonstrate that the VY-LDMF is a reliable technique and should be considered in cases of immediate large thoracic wound reconstruction. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. The Type of Breast Reconstruction May Not Influence Patient Satisfaction in the Chinese Population: A Single Institutional Experience

    PubMed Central

    Chen, Jiaying; Chen, Ying; Hu, Zhen; Liu, Guangyu; Shen, Zhenzhou; Shao, Zhimin; Wu, Jiong

    2015-01-01

    Background The goal of this study was to evaluate patient satisfaction with four common types of breast reconstruction performed at our institution: latissimus dorsi myocutaneous (LDM) flap reconstruction with or without implants, pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction, and free deep inferior epigastric perforator (DIEP) flap reconstruction. Methods A custom survey consisting of questions that assessed general and aesthetic satisfaction was sent to patients who had undergone breast reconstruction in the last 5 years. The clinical data and details of the surgery were also collected from the patients who returned the surveys. We compared satisfaction rates across the four breast reconstruction types and analyzed the effects of various factors on overall general and aesthetic satisfaction rates using a binary logistic regression model. Result A total of 207 (72%) patients completed the questionnaires. Overall, significant differences in general and aesthetic satisfaction among the four procedures were not observed. A multivariate analysis revealed that the factor “complications” (p = 0.001) played a significant role in general satisfaction and that the factors “> 2 years since reconstruction” (p = 0.043) and “age > 35 years” (p = 0.05) played significant roles in overall aesthetic satisfaction. Conclusion The present study demonstrated that the type of breast reconstruction might not influence satisfaction in Chinese patients. PMID:26562294

  14. Functional Reconstruction of Sarcoma Defects Utilising Innervated Free Flaps

    PubMed Central

    Grinsell, Damien; Di Bella, Claudia; Choong, Peter F. M.

    2012-01-01

    Soft-tissue reconstruction following preoperative radiotherapy and wide resection of soft tissue sarcoma remains a challenge. Pedicled and free tissue transfers are an essential part of limb sparing surgery. We report 22 cases of sarcoma treated with radiotherapy and wide excision followed by one-stage innervated free or pedicled musculocutaneous flap transfers. The resection involved the upper limb in 3 cases, the lower limb in 17, and the abdominal wall in 2. The flaps used for the reconstruction were mainly latissimus dorsi and gracilis. The range of motion was restored fully in 14 patients. The muscle strength of the compartment reconstructed was of grades 4 and 5 in all patients except one. The overall function was excellent in all the cases with functional scores of 71.2% in the upper limb and 84% in the lower limb. The only 2 major complications were flap necrosis, both revised with another flap, one of which was innervated with restoration of function. Innervated flaps are valuable alternatives for reconstruction after sarcoma resection in the extremity and in the abdominal wall. The excellent functional results are encouraging, and we believe that innervated muscle reconstruction should be encouraged in the treatment of sarcoma after radiotherapy and wide resection. PMID:22969309

  15. A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

    PubMed

    Kirazlı, Özlem; Tatarlı, Necati; Ceylan, Davut; Hacıoğlu, Hüsniye; Uygun, Seda; Şeker, Aşkın; Keleş, Evren; Çavdar, Safiye

    2013-12-01

    During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists. Georg Thieme Verlag KG Stuttgart · New York.

  16. The use of computer-assisted image analysis in the evaluation of the effect of management systems on changes in the color, chemical composition and texture of m. longissimus dorsi in pigs.

    PubMed

    Zapotoczny, Piotr; Kozera, Wojciech; Karpiesiuk, Krzysztof; Pawłowski, Rodian

    2014-08-01

    The effect of management systems on selected physical properties and chemical composition of m. longissimus dorsi was studied in pigs. Muscle texture parameters were determined by computer-assisted image analysis, and the color of muscle samples was evaluated using a spectrophotometer. Highly significant correlations were observed between chemical composition and selected texture variables in the analyzed images. Chemical composition was not correlated with color or spectral distribution. Subject to the applied classification methods and groups of variables included in the classification model, the experimental groups were identified correctly in 35-95%. No significant differences in the chemical composition of m. longissimus dorsi were observed between experimental groups. Significant differences were noted in color lightness (L*) and redness (a*).

  17. Effects of new polymorphisms in the bovine myocyte enhancer factor 2D (MEF2D) gene on the expression rates of the longissimus dorsi muscle.

    PubMed

    Juszczuk-Kubiak, E; Starzyński, R R; Sakowski, T; Wicińska, K; Flisikowski, K

    2012-08-01

    Myocyte enhancer factor 2D (MEF2D), a product of the MEF2D gene, belongs to the myocyte enhancer factor 2 (MEF2) protein family which is involved in vertebrate skeletal muscle development and differentiation during myogenesis. The aim of the present study was to search for polymorphisms in the bovine MEF2D gene and to analyze their effect on MEF2D mRNA and on protein expression levels in the longissimus dorsi muscle of Polish Holstein-Friesian cattle. Overall, three novel variations, namely, insertion/deletion g.-818_-814AGCCG and g.-211Cdorsi muscle of Polish Holstein-Friesian bulls carrying the three different combined genotypes. The highest MEF2D mRNA and protein levels were estimated in the muscle of bulls with the Ins-C-C/Ins-C-C homozygous genotype as compared to the Del-A-T/Del-A-T homozygotes (P < 0.01) and Ins-C-C/Del-A-T heterozygotes (P < 0.05). A preliminary association study showed no significant differences in the carcass quality traits between bulls with various MEF2D combined genotypes in the investigated population of Polish Holstein-Friesian cattle.

  18. Evaluation of the Activities of Antioxidant Enzyme and Lysosomal Enzymes of the Longissimus dorsi Muscle from Hanwoo (Korean Cattle) in Various Freezing Conditions.

    PubMed

    Kang, Sun Moon; Kang, Geunho; Seong, Pil-Nam; Park, Beomyoung; Kim, Donghun; Cho, Soohyun

    2014-01-01

    This study was conducted to evaluate the activities of antioxidant enzyme (glutathione peroxidase (GSH-Px)) and lysosomal enzymes (alpha-glucopyranosidase (AGP) and beta-N-acetyl-glucosaminidase (BNAG)) of the longissimus dorsi (LD) muscle from Hanwoo (Korean cattle) in three freezing conditions. Following freezing at -20, -60, and -196℃ (liquid nitrogen), LD samples (48 h post-slaughter) were treated as follows: 1) freezing for 14 d, 2) 1 to 4 freeze-thaw cycles (2 d of freezing in each cycle), and 3) refrigeration (4℃) for 7 d after 7 d of freezing. The control was the fresh (non-frozen) LD. Freezing treatment at all temperatures significantly (p<0.05) increased the activities of GSH-Px, AGP, and BNAG. The -196 ℃ freezing had similar effects to the -20℃ and -60℃ freezing. Higher (p<0.05) enzymes activities were sustained in frozen LD even after 4 freeze-thaw cycles and even for 7 d of refrigeration after freezing. These findings suggest that freezing has remarkable effects on the activities of antioxidant enzyme and lysosomal enzymes of Hanwoo beef in any condition.

  19. Transcriptional profiling and miRNA-dependent regulatory network analysis of longissimus dorsi muscle during prenatal and adult stages in two distinct pig breeds.

    PubMed

    Siengdee, P; Trakooljul, N; Murani, E; Schwerin, M; Wimmers, K; Ponsuksili, S

    2013-08-01

    MicroRNAs (miRNAs) and mRNAs establish a complex regulatory network influencing diverse biological pathways including muscle development and growth. Elucidating miRNA-dependent regulatory networks involved in muscle development could provide additional insights into muscle traits largely predefined during prenatal development. The present study aimed to determine differentially expressed transcripts and functional miRNA-mRNA relationships associated with different stages of skeletal muscle development in two pig breeds, German Landrace and Pietrain, distinct in muscle characteristics. A comparative transcriptional profiling of longissimus dorsi muscle tissues from fetuses at 35, 63 and 91 days post-conception as well as adult pigs (180 days postnatum) was performed using the Affymetrix GeneChip porcine genome microarray. Differential expression patterns were identified to be associated with muscularly developmental stages and breed types. The integration of miRNA expression data and ingenuity pathways analysis (ipa) pathway analysis revealed several miRNA-dependent regulatory networks related to muscle growth and development. The present results provide insights into muscle biology for further improvement of porcine meat quality.

  20. Effect of tanniniferous Terminalia chebula extract on rumen biohydrogenation, ∆(9)-desaturase activity, CLA content and fatty acid composition in longissimus dorsi muscle of kids.

    PubMed

    Rana, Madhu Suman; Tyagi, A; Hossain, Sk Asraf; Tyagi, A K

    2012-03-01

    Conjugated linoleic acid, a fatty acid found in milk fat and ruminant meat is one of the functional food components. Modifying fatty acid composition so as to increase CLA and other beneficial PUFA/MUFA level and reducing SFA levels might be a key to enhance the neutraceutical and therapeutic value of ruminant-derived food products. In the present experiment, the effect of supplementation of polyphenol rich Terminalia chebula plant extract at different concentrations (1.06g/kg and 3.18g/kg of body weight in T1 and T2 groups, respectively) was investigated on fatty acid composition of rumen fluid, plasma, intramuscular fat and Δ9-desaturase activity in longissimus dorsi muscle of crossbred kids. Total MUFA and PUFA content in muscle were enhanced by 25 and 35%, respectively, whereas SFA was reduced by 20% thereby improving the desaturation index. Δ9-desaturase activity also increased by 47% resulting in an enhancement of total CLA content (58.73%) in muscle.

  1. The influence of biochemical differences on the variation in tenderness of M. longissimus dorsi of Belgian Blue steers managed homogenously pre and post-slaughter.

    PubMed

    Maher, S C; Mullen, A M; Buckley, D J; Kerry, J P; Moloney, A P

    2005-02-01

    The objective of this experiment was to determine the contribution of some biochemical processes of postmortem muscle to the variation in tenderness of beef from Belgian Blue bull cross Holstein-Friesian steers (n=10). These animals were managed optimally from conception to consumption with the aim of reducing tenderness variation. The M. longissimus dorsi (LD) from the left hand side (LHS) and the right hand side (RHS) were analysed for variation in tenderness using Bartletts test. The quality measurements included pH, temperature, Warner Bratzler shear force, sensory tenderness, chemical composition and sarcomere length. Biochemical measurements included myofibrilar proteolysis, glycolytic potential, adenine/inosine ratio and collagen content. No difference for variances or means were observed between LHS and RHS for chemical, quality or biochemical attributes. Biochemical variation was greater than the variation observed in most of the quality attributes measured. Proteolysis was the main biochemical contributor to the variation in shear force tenderness after 2 and 7 as postmortem, but not sensory tenderness. Glycolysis levels and adenine/inosine ratio explained much of the variation in sensory tenderness, but not WBSF. Collagen content in the LD muscles did not explain variation in shear force or sensory tenderness. This would suggest biochemical variation is one of the main contributors to variation in tenderness of beef managed optimally pre- and post-slaughter.

  2. The level of heat shock protein 90 in pig Longissimus dorsi muscle and its relationship with meat pH and quality.

    PubMed

    Zhang, Muhan; Wang, Daoying; Geng, Zhiming; Bian, Huan; Liu, Fang; Zhu, Yongzhi; Xu, Weimin

    2014-12-15

    The 90 kDa heat shock protein (HSP90) is a molecular chaperone that participates in various cellular processes, the role and significance of HSP90 in postmortem muscle though remains unclear. In the present study, pig Longissimus dorsi muscles, categorized into three pH groups, were tested for HSP90 levels and meat quality parameters (i.e. water holding capacity, colour, tenderness and lipid oxidation). The muscles with a high initial pH (pHi) group (pH>6.4) possessing the greatest water holding capacity and lightness, contained the highest HSP90 level, followed by intermediate (6.0-6.4) and low pHi groups (pH<6.0). Statistical analysis indicated HSP90 level was significantly and negatively correlated with cooking loss, drip loss, and lightness (r=-0.797, -0.785, -0.604, respectively, P<0.01). The results suggest that HSP90 may play a crucial role in water retention of meat and may be involved in postmortem meat quality development.

  3. Conjugated linoleic acids content in M.longissimus dorsi of Hanwoo steers fed a concentrate supplemented with soybean oil, sodium bicarbonate-based monensin, fish oil.

    PubMed

    Song, M K; Jin, G L; Ji, B J; Chang, S S; Jeong, J; Smith, S B; Choi, S H

    2010-06-01

    We hypothesized that increasing ruminal pH would lead to enrichment of adipose tissue with conjugated linoleic acid (CLA). Twenty-four Korean native (Hanwoo) steers were used to investigate the additive effects of monensin (30ppm, SO-BM) and/or fish oil (0.7%, SO-BMF) in the diets along with soybean oil (7%) and sodium bicarbonate (0.5%, SO-B) on cis-9, trans-11 and trans-10, cis-12 CLAs in adipose tissue. The steers were assigned to randomly four groups of six animals each based on body weight. The control group (CON) was fed a commercial concentrate for the late fattening stage. Supplementation of oil and sodium bicarbonate reduced feed intake and daily gain, and fish oil further decreased feed intake (P<0.001) and daily gain (P<0.087) compared to steers fed other diets. Total CLA and CLA isomers in M.longissimus dorsi were not affected when steers were fed SO-B and SO-BM diets compared with those of steers fed CON and SO-BMF diets. However, total poly unsaturated fatty acids were higher (P=0.03) in steers fed SO than in CON steers.

  4. Evaluation of the Activities of Antioxidant Enzyme and Lysosomal Enzymes of the Longissimus dorsi Muscle from Hanwoo (Korean Cattle) in Various Freezing Conditions

    PubMed Central

    2014-01-01

    This study was conducted to evaluate the activities of antioxidant enzyme (glutathione peroxidase (GSH-Px)) and lysosomal enzymes (alpha-glucopyranosidase (AGP) and beta-N-acetyl-glucosaminidase (BNAG)) of the longissimus dorsi (LD) muscle from Hanwoo (Korean cattle) in three freezing conditions. Following freezing at -20, -60, and -196℃ (liquid nitrogen), LD samples (48 h post-slaughter) were treated as follows: 1) freezing for 14 d, 2) 1 to 4 freeze-thaw cycles (2 d of freezing in each cycle), and 3) refrigeration (4℃) for 7 d after 7 d of freezing. The control was the fresh (non-frozen) LD. Freezing treatment at all temperatures significantly (p<0.05) increased the activities of GSH-Px, AGP, and BNAG. The -196 ℃ freezing had similar effects to the -20℃ and -60℃ freezing. Higher (p<0.05) enzymes activities were sustained in frozen LD even after 4 freeze-thaw cycles and even for 7 d of refrigeration after freezing. These findings suggest that freezing has remarkable effects on the activities of antioxidant enzyme and lysosomal enzymes of Hanwoo beef in any condition. PMID:26761669

  5. Association of DNA Methylation Levels with Tissue-specific Expression of Adipogenic and Lipogenic Genes in Longissimus dorsi Muscle of Korean Cattle

    PubMed Central

    Baik, M.; Vu, T. T. T.; Piao, M. Y.; Kang, H. J.

    2014-01-01

    Epigenetic factors, such as DNA methylation status, may regulate adipogenesis and lipogenesis, thus affecting intramuscular fat (IMF) deposition in longissimus dorsi muscle (LM) of beef cattle. In Korean cattle steers, the LM consists mainly of muscle tissue. However, the LM tissue also contains IMF. We compared the gene expression levels between the IMF and muscle portions of the LM after tissue separation. Real-time polymerase chain reaction analysis showed that the mRNA levels of both adipogenic peroxisome proliferator-activated receptor gamma isoform 1 (PPARG1) and lipogenic fatty acid binding protein 4 (FABP4) were higher (p<0.01) in the IMF than in the muscle portion of the LM. We determined DNA methylation levels of regulatory regions of the PPARG1 and FABP4 genes by pyrosequencing of genomic DNA. DNA methylation levels of two of three CpG sites in the PPARG1 gene promoter region were lower (p<0.05) in the IMF than in the muscle portion of the LM. DNA methylation levels of all five CpG sites from the FABP4 gene promoter region were also lower (p<0.001) in the IMF than in the muscle portion. Thus, mRNA levels of both PPARG1 and FABP4 genes were inversely correlated with DNA methylation levels in regulatory regions of CpG sites of the corresponding gene. Our findings suggest that DNA methylation status regulates tissue-specific expression of adipogenic and lipogenic genes in the IMF and muscle portions of LM tissue in Korean cattle. PMID:25178302

  6. Differential Expression of PPARγ, FASN, and ACADM Genes in Various Adipose Tissues and Longissimus dorsi Muscle from Yanbian Yellow Cattle and Yan Yellow Cattle

    PubMed Central

    Ji, Shuang; Yang, Runjun; Lu, Chunyan; Qiu, Zhengyan; Yan, Changguo; Zhao, Zhihui

    2014-01-01

    The objective of this study was to investigate the correlation between cattle breeds and deposit of adipose tissues in different positions and the gene expressions of peroxisome proliferator-activated receptor gamma (PPARγ), fatty acid synthase (FASN), and Acyl-CoA dehydrogenase (ACADM), which are associated with lipid metabolism and are valuable for understanding the physiology in fat depot and meat quality. Yanbian yellow cattle and Yan yellow cattle reared under the same conditions display different fat proportions in the carcass. To understand this difference, the expression of PPARγ, FASN, and ACADM in different adipose tissues and longissimus dorsi muscle (LD) in these two breeds were analyzed using the Real-time quantitative polymerase chain reaction method (qRT-PCR). The result showed that PPARγ gene expression was significantly higher in adipose tissue than in LD in both breeds. PPARγ expression was also higher in abdominal fat, in perirenal fat than in the subcutaneous fat (p<0.05) in Yanbian yellow cattle, and was significantly higher in subcutaneous fat in Yan yellow cattle than that in Yanbian yellow cattle. On the other hand, FASN mRNA expression levels in subcutaneous fat and abdominal fat in Yan yellow cattle were significantly higher than that in Yanbian yellow cattle. Interestingly, ACADM gene shows greater fold changes in LD than in adipose tissues in Yan yellow cattle. Furthermore, the expressions of these three genes in lung, colon, kidney, liver and heart of Yanbian yellow cattle and Yan yellow cattle were also investigated. The results showed that the highest expression levels of PPARγ and FASN genes were detected in the lung in both breeds. The expression of ACADM gene in kidney and liver were higher than that in other organs in Yanbian yellow cattle, the comparison was not statistically significant in Yan yellow cattle. PMID:25049920

  7. Effects of Dietary Restriction on the Expression of Lipid Metabolism and Growth Hormone Signaling Genes in the Longissimus dorsi Muscle of Korean Cattle Steers

    PubMed Central

    Kang, H. J.; Trang, N. H.; Baik, M.

    2015-01-01

    This study determined the effects of dietary restriction on growth and the expression of lipid metabolism and growth hormone signaling genes in the longissimus dorsi muscle (LM) of Korean cattle. Thirty-one Korean cattle steers (average age 10.5 months) were allocated to normal (N; n = 16) or dietary restriction (DR; n = 15) groups. The feeding trial consisted of two stages: for the 8-month growing period, the DR group was fed 80% of the food intake of the normal diet, and for the 6-month growth-finishing period, the DR group was fed a DR total mixed ration with 78.4% of the crude protein and 64% of the net energy for gain of the normal diet. The LM was biopsied 5 months (period 1 [P1] at 15.5 months of age) and 14 months (period 2 [P2] at 24.5 months of age) after the start of feeding. The mRNA levels were determined using real-time polymerase chain reaction. Body weight, daily feed intake, average daily gain, and feed efficiency were lower in the DR group compared with the normal group at both P1 and P2. At P1, the lipogenic fatty acid synthase (FASN) mRNA levels were lower (p<0.05) in the DR group compared with the normal group. The DR group tended (p = 0.06) to have higher of levels of growth hormone receptor (GHR) mRNA than the normal group. At P2, the DR group tended to have lower (p = 0.06) androgen receptor (AR) mRNA levels than the normal group. In conclusion, our results demonstrate that dietary restriction partially decreases the transcription of lipogenic FASN and growth hormone signaling AR genes, but increases transcription of the GHR gene. These changes in gene transcription might affect body fat accumulation and the growth of the animals. PMID:26104528

  8. Effects of live weight at slaughter on fatty acid composition of Longissimus dorsi and Biceps femoris muscles of indigenous Lori goat.

    PubMed

    Kiani, Ali; Fallah, Rozbeh

    2016-01-01

    This study aimed to determine fatty acid (FA) composition of Longissimus dorsi (LD) and Biceps femoris (BF) muscles of an Iranian indigenous goat (Lori goat) at two live weights at slaughter (LWS). Twenty male Lori goats (5 to 8 months) raised in nomadic system were slaughtered either at LWS less than 20 kg (light) or LWS more than 30 kg (heavy). Carcass dressing and FA composition of intramuscular fat of LD and BF muscles as well as cholesterol content of LD muscle were determined. Heavy goats had higher dressing percentage than light ones (42.7vs.39.3%, P < 0.01). The predominant n-6 FA were C18:2, and C20:4 while C22:5, C20:5, C18:3, C20:3, and C22:6 were the n-3 FA detected. Polyunsaturated and saturated FA contributed 22% and 36% of the total FA in both muscles, respectively. Palmitic acid (C16:0) of LD was higher in heavy compared to the light goats (P < 0.05). BF muscle had higher α-linolenic acid (18:3 n-3) as percentage than LD muscle (P < 0.05). The ratio of n-6/n-3 FA and polyunsaturated/saturated FA were 3.8 and 0.6, respectively. Cholesterol content of LD muscle of light and heavy goats were 71.2 ± 16 and 59.5 ± 14 mg per 100 g fresh meat respectively. In conclusion, desirable PUFA/SFA (0.6) and n-3/n-6 ratio (3.8) found in indigenous Lori goat propose healthy source of lean meat for the consumers.

  9. Profiling and characterization of a longissimus dorsi muscle microRNA dataset from an F2 Duroc × Pietrain pig resource population.

    PubMed

    Daza, Kaitlyn R; Steibel, Juan P; Velez-Irizarry, Deborah; Raney, Nancy E; Bates, Ronald O; Ernst, Catherine W

    2017-09-01

    To elucidate the effects of microRNA (miRNA) regulation in skeletal muscle of adult pigs, miRNA expression profiling was performed with RNA extracted from longissimus dorsi (LD) muscle samples from 174 F2 pigs (~ 5.5 months of age) from a Duroc × Pietrain resource population. Total RNA was extracted from LD samples, and libraries were sequenced on an Illumina HiSeq 2500 platform in 1 × 50 bp format. After processing, 232,826,977 total reads were aligned to the Sus scrofa reference genome (v10.2.79), with 74.8% of total reads mapping successfully. The miRDeep2 software package was utilized to quantify annotated Sus scrofa mature miRNAs from miRBase (Release 21) and to predict candidate novel miRNA precursors. Among the retained 295 normalized mature miRNA expression profiles ssc-miR-1, ssc-miR-133a-3p, ssc-miR-378, ssc-miR-206, and ssc-miR-10b were the most abundant, all of which have previously been shown to be expressed in pig skeletal muscle. Additionally, 27 unique candidate novel miRNA precursors were identified exhibiting homologous sequence to annotated human miRNAs. The composition of classes of small RNA present in this dataset was also characterized; while the majority of unique expressed sequence tags were not annotated in any of the queried databases, the most abundantly expressed class of small RNA in this dataset was miRNAs. This data provides a resource to evaluate miRNA regulation of gene expression and effects on complex trait phenotypes in adult pig skeletal muscle. The raw sequencing data were deposited in the Sequence Read Archive, BioProject PRJNA363073.

  10. Association of DNA Methylation Levels with Tissue-specific Expression of Adipogenic and Lipogenic Genes in Longissimus dorsi Muscle of Korean Cattle.

    PubMed

    Baik, M; Vu, T T T; Piao, M Y; Kang, H J

    2014-10-01

    Epigenetic factors, such as DNA methylation status, may regulate adipogenesis and lipogenesis, thus affecting intramuscular fat (IMF) deposition in longissimus dorsi muscle (LM) of beef cattle. In Korean cattle steers, the LM consists mainly of muscle tissue. However, the LM tissue also contains IMF. We compared the gene expression levels between the IMF and muscle portions of the LM after tissue separation. Real-time polymerase chain reaction analysis showed that the mRNA levels of both adipogenic peroxisome proliferator-activated receptor gamma isoform 1 (PPARG1) and lipogenic fatty acid binding protein 4 (FABP4) were higher (p<0.01) in the IMF than in the muscle portion of the LM. We determined DNA methylation levels of regulatory regions of the PPARG1 and FABP4 genes by pyrosequencing of genomic DNA. DNA methylation levels of two of three CpG sites in the PPARG1 gene promoter region were lower (p<0.05) in the IMF than in the muscle portion of the LM. DNA methylation levels of all five CpG sites from the FABP4 gene promoter region were also lower (p<0.001) in the IMF than in the muscle portion. Thus, mRNA levels of both PPARG1 and FABP4 genes were inversely correlated with DNA methylation levels in regulatory regions of CpG sites of the corresponding gene. Our findings suggest that DNA methylation status regulates tissue-specific expression of adipogenic and lipogenic genes in the IMF and muscle portions of LM tissue in Korean cattle.

  11. Comparisons of different myosin heavy chain types, AMPK, and PGC-1α gene expression in the longissimus dorsi muscles in Bama Xiang and Landrace pigs.

    PubMed

    Huang, Y N; Ao, Q W; Jiang, Q Y; Guo, Y F; Lan, G Q; Jiang, H S

    2016-07-14

    Bama Xiang and Landrace pigs are the local fatty and lean breeds, respectively, in China. We compared differences in carcass traits, meat quality traits, and myosin heavy chain (MyHC) types in the longissimus dorsi muscles between Bama Xiang and Landrace pigs. This was done in pigs of the same age, using real-time PCR, to investigate the relationship between MyHC fiber types and carcass characteristics, meat quality traits, and the key factors regulating muscle fiber type. Bama Xiang pigs exhibited smaller size and slower growth than Landrace pigs (P < 0.01). We found that the superior meat quality, especially the high intramuscular fat (IMF) content in Bama Xiang pig, was related to elevated type I oxidative muscle fiber content (P < 0.01). In contrast, Landrace pig muscle had a higher glycolytic type IIb muscle fiber content (P < 0.01). MyHC I gene expression was significantly positively correlated with backfat thickness and IMF content (P < 0.01). MyHC IIb was significantly negatively correlated with IMF content (P < 0.05), and positively correlated with carcass yield (P < 0.05). AMP-activated protein kinase and peroxisome proliferator-activated receptor-g coactivator-1a are suggested to be the two key factors regulating muscle fiber type in pigs. Our results indicate that muscle fiber composition is one of the key differences leading to the differences of meat quality between Bama Xiang and Landrace pigs. These results may provide a theoretical basis for further studies of the molecular mechanism underlying the excellent meat quality of the Bama Xiang pig.

  12. Effects of supplementation of rumen-protected choline on growth performance, meat quality and gene expression in longissimus dorsi muscle of lambs.

    PubMed

    Li, Huawei; Wang, Hongrong; Yu, Lihuai; Wang, Mengzhi; Liu, Shimin; Sun, Lisha; Chen, Qing

    2015-01-01

    This study determined the effects of rumen-protected choline (RPC) on growth performance, blood lipids, meat quality and expression of genes involved in fatty-acid metabolism in young lambs. A total of 24 Dorper × Hu lambs (about 20 kg body weight) were kept in individual pens and fed diets with 0%, 0.25%, 0.50% and 0.75% RPC for 60 d. Supplementation of 0.25% RPC increased average daily gain of lambs, whereas treatments had no significant effect on feed intake. The pH values of meat were increased at 0.25% RPC and both, dripping loss and shear force of meat, were significantly decreased in RPC-supplemented lambs. No significant changes were observed for dressing percentage and intramuscular fat. RPC supplementations had no significant effect on the concentrations of triglycerides and cholesterols in serum, but the concentration of high-density lipoprotein was decreased at 0.50% RPC and that of low-density lipoprotein was increased at 0.75% RPC. In m. longissimus dorsi, the expressions of cluster of differentiation 36 (CD36), acetyl-CoA carboxylase (ACC) and fatty-acid synthase (FASN) genes were increased at 0.25% RPC. Supplementation of 0.75% RPC increased the expressions of lipoprotein lipase (LPL) and FASN genes, decreased the expression of ACC gene and had no effect on CD36 gene. The results of this study showed that supplementation of 0.25% RPC could promote growth performance of lambs and improve meat quality. This may be mediated by effects on blood lipid profiles and the metabolism of fatty acids in skeleton muscles. However, the beneficial effects of 0.25% RPC supplementation need to be validated with a larger number of animals. Higher doses, particularly 0.75% RPC, showed adverse effects on live weight gain and ACC expression.

  13. Evaluation of a compressive-type skeletal muscle pump for cardiac assistance.

    PubMed

    Mizuhara, H; Koshiji, T; Nishimura, K; Nomoto, S; Matsuda, K; Ban, T

    1999-01-01

    Recent investigations have focused on using the latissimus dorsi muscle for cardiac assistance. Although cardiomyoplasty has been applied clinically, other procedures remain experimental, but promising, modes of cardiac assistance. We assessed the latissimus dorsi muscle as an in situ energy source for circulatory assist devices. We developed a pneumatic chamber as a compressive-type muscle actuator. The chamber was implanted under the latissimus dorsi muscle and converted contractile power into pneumatic pressure. The effect of chamber position and size and the influence on muscle blood flow were examined. After muscle conditioning, the pump performance of a circulatory assist device driven by the chamber was evaluated. The chamber functioned better when placed in the proximal position of the latissimus dorsi muscle. The size affected the generated pneumatic pressure, and the higher resting pressure of the chamber reduced the muscle blood flow. The maximum stroke work of the circulatory assist device was greater than that of the right ventricle but less than that of the left ventricle. The chamber could drive the circulatory assist device against the systemic range of afterload in which a high preload was available. Long-term adhesion surrounding the chamber reduced the pressure generation capability. The compressive-type muscle actuator using the latissimus dorsi muscle generated acceptable hemodynamic work for right ventricular bypass or aortic counterpulsation.

  14. Wnt/β-catenin signaling and adipogenic genes are associated with intramuscular fat content in the longissimus dorsi muscle of Korean cattle.

    PubMed

    Jeong, J Y; Kim, J S; Nguyen, T H; Lee, H-J; Baik, M

    2013-12-01

    Intramuscular fat (IMF) is an important trait that influences beef quality. In two studies, we examined the possible involvement of the Wnt/β-catenin signaling pathway in IMF deposition in Korean cattle. In study 1, using a group of bulls and steers, we found that castration, a non-genetic factor, decreased (P < 0.01) the expression of both the WNT10B and CTNNB1 genes, whereas it increased the expression of the Wnt antagonist secreted frizzled-related proteins 4 (SFRP4, P < 0.001) and the adipogenic CCAAT/enhancer binding protein (C/EPB), alpha (CEBPA, P < 0.001) and peroxisome proliferator-activated receptor gamma (PPARG, P < 0.05) genes in longissimus dorsi muscle (LM) tissue. The WNT10B and CTNNB1 mRNA levels showed strong (P < 0.001) negative correlations (r = -0.68 and r = -0.73 respectively) with the IMF content, whereas the SFRP4, CEBPA and PPARG mRNA levels showed strong (P < 0.01) positive correlations (r = 0.70, 0.70 and 0.64 respectively) with the IMF content. Large variation still exists in the IMF content of steers, implying that genetic factors affect IMF deposition. Using a different group of steers, a correlation analysis in study 2 also showed that the expression of the WNT10B and CTNNB1 genes, and SFRP4 and adipogenic genes was negatively and positively associated with the IMF content respectively. Our findings suggest that downregulation of the Wnt/β-catenin signaling pathway genes, but upregulation of Wnt antagonist SFRP4 and adipogenic gene expression following castration, contributes to increased IMF deposition in the LM. Our results demonstrate that both non-genetic factors (castration) and genetic variation within the steer group affect the gene expression pattern of the Wnt/β-catenin signaling pathway. © 2013 The Authors, Animal Genetics © 2013 Stichting International Foundation for Animal Genetics.

  15. Effects of Gas Composition in the Modified Atmosphere Packaging on the Shelf-life of Longissimus dorsi of Korean Native Black Pigs-Duroc Crossbred during Refrigerated Storage.

    PubMed

    Muhlisin; Panjono; Kim, Dong Soo; Song, Yeong Rae; Lee, Sung-Jin; Lee, Jeong Koo; Lee, Sung Ki

    2014-08-01

    This study was conducted to observe the effects of gas composition in modified atmosphere packaging (MAP) on the shelf-life of Longissimus dorsi of Korean Native Black Pigs-Duroc Crossbred (KNP×D) during refrigerated storage. Muscle sample was obtained from the left side of carcass of seven months old of KNP×D barrow. The sample was sliced into 1 cm in thickness, placed on trays (two slices/tray) and filled with different gas composition, i.e. 0:20:80/O2:CO2:N2 (MAP1), 30:20:50/O2:CO2:N2 (MAP2) and 70:20:10/O2:CO2:N2 (MAP3). Other slices of sample were vacuum packed (VP) as a control. All packs were stored at 5±1°C. At 12 d of storage, pH value of MAP2 and MAP3 were higher (p<0.05) than that of MAP1 and pH value of MAP1 was higher (p<0.05) than that of VP. At 6 d of storage, redness (a*) value of MAP2 and MAP3 were higher (p<0.05) than that of VP and MAP1 and, at 9 and 12 d of storage, redness value of MAP3 was higher (p<0.05) than that of VP, MAP1, and MAP2. At 3, 6, 9, and 12 d of storage, the 2-thiobarbituric acid reactive substances (TBARS) value of MAP3 was higher than that of MAP2 and TBARS value of MAP2 was higher than that of VP and MAP1. At 3, 6, 9, and 12 d of storage, volatile basic nitrogen values of MAP2 and MAP3 were higher (p<0.05) than those of VP and MAP1. At 3 d of storage, total aerobic plate counts of MAP2 and MAP3 were higher (p<0.05) than those of VP and MAP1 and, at 6 d of storage, total aerobic plate counts of MAP3 was higher (p<0.05) than that of MAP1 and MAP2. However, there was no significant different total aerobic plate count among MAP1, MAP2, and MAP3 at 9 and 12 d of storage. There was no significant different total anaerobic plate count among MAP1, MAP2, and MAP3 during storage. It is concluded that the MAP containing 30:20:50/O2:CO2:N2 gas composition (MAP2) might be ideal for better meat quality for KNP×D meat.

  16. Glycolytic potential and activity of adenosine monophosphate kinase (AMPK), glycogen phosphorylase (GP) and glycogen debranching enzyme (GDE) in steer carcasses with normal (<5.8) or high (>5.9) 24h pH determined in M. longissimus dorsi.

    PubMed

    Apaoblaza, A; Galaz, A; Strobel, P; Ramírez-Reveco, A; Jeréz-Timaure, N; Gallo, C

    2015-03-01

    Muscle glycogen concentration (MGC) and lactate (LA), activity of glycogen debranching enzyme (GDE), glycogen phosphorylase (GP) and adenosine monophosphate kinase (AMPK) were determined at 0.5h (T0) and 24h (T24) post-mortem in Longissimus dorsi samples from 38 steers that produced high pH (>5.9) and normal pH (<5.8) carcasses at 24h postmortem. MGC, LA and glycolytic potential were higher (P<0.05) in normal pH carcasses. GDE activity was similar (P>0.05) in both pH categories. GP activity increased between T0 and T24 only in normal pH carcasses. AMPK activity was four times higher in normal pH v/s high pH carcasses, without changing its activity over time. Results reinforce the idea that differences in postmortem glycogenolytic/glycolytic flow in L. dorsi of steers showing normal v/s high muscle pH at 24h, could be explained not only by the higher initial MGC in normal pH carcasses, but also by a high and sustained activity of AMPK and an increased GP activity at 24h postmortem.

  17. Neurovascular free-muscle transfer for the treatment of established facial paralysis following ablative surgery in the parotid region.

    PubMed

    Takushima, Akihiko; Harii, Kiyonori; Asato, Hirotaka; Ueda, Kazuki; Yamada, Atsushi

    2004-05-01

    Neurovascular free-muscle transfer for facial reanimation was performed as a secondary reconstructive procedure for 45 patients with facial paralysis resulting from ablative surgery in the parotid region. This intervention differs from neurovascular free-muscle transfer for treatment of established facial paralysis resulting from conditions such as congenital dysfunction, unresolved Bell palsy, Hunt syndrome, or intracranial morbidity, with difficulties including selection of recipient vessels and nerves, and requirements for soft-tissue augmentation. This article describes the authors' operative procedure for neurovascular free-muscle transfer after ablative surgery in the parotid region. Gracilis muscle (n = 24) or latissimus dorsi muscle (n = 21) was used for transfer. With gracilis transfer, recipient vessels comprised the superficial temporal vessels in 12 patients and the facial vessels in 12. For latissimus dorsi transfer, recipient vessels comprised the facial vessels in 16 patients and the superior thyroid artery and superior thyroid or internal jugular vein in four. Facial vessels on the contralateral side were used with interpositional graft of radial vessels in the remaining patient with latissimus dorsi transfer. Cross-face nerve grafting was performed before muscle transfer in 22 patients undergoing gracilis transfer. In the remaining two gracilis patients, the ipsilateral facial nerve stump was used as the primary recipient nerve. Dermal fat flap overlying the gracilis muscle was used for cheek augmentation in one patient. In the other 23 patients, only the gracilis muscle was used. With latissimus dorsi transfer, the ipsilateral facial nerve stump was used as the recipient nerve in three patients, and a cross-face nerve graft was selected as the recipient nerve in six. The contralateral facial nerve was selected as the recipient nerve in 12 patients, and a thoracodorsal nerve from the latissimus dorsi muscle segment was crossed through the upper lip

  18. Comparison of neck and upper-limb muscle activities between able-bodied and paraplegic individuals during wheelchair propulsion on the ground.

    PubMed

    Kim, Sang Jin; Park, So Hyun; Lee, Chang-Ryeol

    2015-05-01

    [Purpose] This study compared the muscle activities of the neck and upper-limb muscles between able-bodied individuals and persons with paraplegia during wheelchair propulsion on the ground. [Subjects and Methods] The muscle activities of the neck and upper-limb muscles of 8 normal individuals and 8 individuals with paraplegia were analyzed during wheelchair propulsion. The activities of the latissimus dorsi, pectoralis major, anterior/posterior deltoids, triceps brachii, extensor carpi radialis, and sternocleidomastoid muscles were assessed. [Results] The paraplegic group showed significantly higher sternocleidomastoid activity than the normal group. Latissimus dorsi activity was also higher in the paraplegia group than in the normal group, but the difference was not significant. There were no significant differences in the other muscle activities between groups. [Conclusion] Paraplegic patients tend to use the sternocleidomastoid and latissimus dorsi muscles with greater degrees of activity. Therefore, physiotherapists should not overlook the treatment of these muscles for paraplegic patients who are long-term wheelchair users.

  19. [Systemic therapy for defects of skin and soft tissue on the knees after severe trauma or burn].

    PubMed

    Tao, Ke; Hu, Da-hai; Zhu, Xiong-xiang; Han, Jun-tao; Zheng, Zhao; Xie, Song-tao; Ge, Jin-bo; Hu, Xiao-long

    2013-04-01

    To explore the methods of systemic treatment of defects of skin and soft tissue on the knees after severe trauma or burn. Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011. The injury areas on the knees ranged from 5 cm×4 cm to 30 cm×20 cm. The wounds were treated with radical debridement, vacuum sealing drainage, and douche through dripping to control infection in early stage. Then they were covered with transplantation of skin grafts plus flap or only with flap. Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used. The flap size ranged from 6 cm×5 cm to 32 cm×22 cm. The rehabilitation training of the knee joints was carried out in the early stage after wound healing. All free skin grafts and flaps used in 15 patients survived. Thirteen of them were primarily healed, while some small parts of skin grafts of the other two patients were in poor condition because of infection, and they healed after another session of skin transplantation. Infection occurred under the free flap in one of the 5 patients transplanted with flaps only, which was healed after continuous douche through dripping and another surgical debridement following wet dressing. The knee joints were in good function during the follow-up period of 1 - 3 years. The systemic therapy of radical debridement, vacuum sealing drainage technique, douche through dripping, transplantation of large autologous grafts and flaps, and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.

  20. Surgical treatment of a case of recurrent irradiated basal cell carcinoma of the head with a large soft tissue and bone defect

    PubMed Central

    Ioan Petre, Florescu; Giuglea, Carmen; Eugen, Turcu; Silviu, Marinescu; Crenguta, Jecan; Gorgan, Mircea; Narcisa, Bucur

    2009-01-01

    Taking into account the great number of skin malignances that occur in the head and neck regions, problems related to their surgical treatment represent a constant concern for plastic surgeons. They have to deal with the difficulties of radical excision and also with reconstructive possibilities. More than 2/3 of these malignances are basal cell carcinomas, which, if left untreated might become very invasive, surgical treatment being more difficult in such cases. Recurrent carcinomas combined with radiation injuries represent a serious challenge even for experienced surgeons regarding the size of the defect and anatomical structures involved. In this paper we present a case of a patient with basal cell carcinoma of the parietal region and the reconstructive treatment involving neurosurgery and plastic surgery team approach, using microsurgery techniques. We also present the difficulties of the case as well as the final outcome that we consider the best option for the patient. The neurosurgical stage consisted in fongus removal, excluding all brain tissue located outside the dural limits, craniectomy, duraplasty and cranioplasty. Because of the large size of the defect and also because the local resources were exhausted we chose as a covering solution the free tissue transfer consisting in a latissimus dorsi musculocutaneous flap. The difficulties of these cases consist both in the aim of radical excision and the limited reconstructive options. In this case, our collaboration with the neurosurgery team proved to be crucial, permitting us to solve this case in a single operative time, with deep excision, reconstruction of the dura mater and cranioplasty, and reconstruction of the soft tissues with microsurgical free transfer. PMID:20112470

  1. Poland’s Anomaly: Natural History and Long-Term-Results of Chest Wall Reconstruction in 33 Patients

    DTIC Science & Technology

    1988-12-01

    five patients had partial or complete absence of the ipsilateral latissimus dorsi muscle, and nine patients had absence of the serratus anterior muscle...defect has changed consid- to the anterior chest wall while preserving the neurovascular erably over the past decade, and although newer tech- pedicle...dorsi, serratus an- inations, muscle testing, and standard photography were terior, and other nearby structures.3-7 Renal hypoplasia, performed on

  2. Salvage reconstruction of the oesophagus: a retrospective study of 15 cases.

    PubMed

    Oki, Masanao; Asato, Hirotaka; Suzuki, Yasutoshi; Umekawa, Kohei; Takushima, Akihiko; Okazaki, Mutsumi; Harii, Kiyonori

    2010-04-01

    Salvage reconstruction of the oesophagus is still considered a challenging procedure for all head and neck surgeons. The risk of postoperative infection and delayed wound healing is high because of thick scar formation and persistent inflammation. Furthermore, recipient vessels for free tissue transfer or vascular supercharge are not always available. Alimentary tract reconstruction with skin or musculocutaneous flap may be necessary, but this method is susceptible to fistula formation.[Nakatsuka T, Harii K, Asato H, et al. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scand J Plast Reconstr Surg Hand Surg 1998; 32: 307-10] In the past 10 years, we have experienced 15 cases of salvage reconstruction of the oesophagus after prior cancer treatment or aorto-oesophageal fistula; the cervical oesophagus was reconstructed in five cases and the cervico-thoracic oesophagus in 10. In four cases of cervical oesophagus and six of cervico-thoracic oesophagus we performed free jejunal transfer including two long segment transfers with double vascular pedicle. The cervico-thoracic oesophagus was also reconstructed with pedicled alimentary tract transfer (colon interposition or jejunal pull-up) with vascular supercharge in four cases. In one case, cervical oesophageal defect was reconstructed with a latissimus dorsi musculocutaneous flap. We also used a deltopectoral flap to cover the skin defect in three cases. In three cases, a second salvage operation was necessary because of flap necrosis that was caused by unreliable recipient vessels resulting from scar formation and persistent inflammation. Successful restoration of the oesophagus and oral alimentation was achieved in 11 cases. From this study, we concluded that free jejunal transfer is a useful procedure for salvage reconstruction of the oesophagus, particularly for cervical oesophagus or short oesophageal defects. Nonetheless, surgeons

  3. Changes in the fatty acid composition of M. longissimus dorsi of lamb during storage in a high-oxygen modified atmosphere at different levels of dietary vitamin E supplementation.

    PubMed

    Alvarez, Inma; De La Fuente, Jesús; Cañeque, Vicente; Lauzurica, Sara; Pérez, Concha; Díaz, María Teresa

    2009-01-14

    The effect of vitamin E supplementation on fatty acid composition during storage of lamb meat packed in a high-oxygen modified atmosphere was studied. Lambs were fed with diets supplemented with four levels of vitamin E (0, 250, 500, and 1000 mg acetate-alpha-tocopherol/kg feed). Slices of M. longissimus dorsi were packed in a high-oxygen modified atmosphere (70% O2:30% CO2) and stored at 2 +/- 1 degrees C in the dark for 14, 21, and 28 days. The nonsupplemented group (E0) showed an increase in saturated fatty acids (SFA) and monounsaturated fatty acids and a reduction in polyunsaturated fatty acids (PUFA) in total fatty acids. The proportion of SFA and PUFA was unchanged in the supplemented groups (E250, E500, and E1000). The supplementation with 250 mg acetate-alpha-tocopherol/kg feed prevented the oxidation of PUFA in the total lipids and in the polar lipids fraction, while 500 mg acetate-alpha-tocopherol/kg feed was necessary to prevent the oxidation of PUFA in free fatty acids. Supplementing vitamin E not only inhibited lipid oxidation but also maintained nutritional value [essential fatty acids, linoleic acid (C18:2n-6) and linolenic acid (C18:3n-3), and beneficial fatty acids, eicosapentaenoic acid (C20:5n-3) and docosahexaenoic acid (C22:6n-3)] throughout the storage period.

  4. [The concentration of ascorbic acid in the liver, the cerebrum, the kidney, the adrenal glands and the musculus longissimus dorsi of dog fetuses, dogs and cats of different ages].

    PubMed

    Kuba, M; Piechotta, D; Kolb, E; Späth, H; Wahren, M; Völker, L

    1993-01-01

    In dog fetuses aged of 45 and 55 days as well as in dogs and cats of different ages the body weight and the concentration of ascorbic acid in different tissues were analysed. In the liver, the highest concentration was determined in the dogs aged 28 days (432 +/- 71 micrograms/g wet weight) and in the cats aged of 42 days (474 +/- 85 micrograms/g). In the cerebrum the highest concentration was found in dog fetuses aged 55 days (821 +/- 75 micrograms/g) and in cats aged 1 to 3 days (888 +/- 56 micrograms/g). In the kidneys and in the M. longissimus dorsi, the concentration was also in part age-dependent. The concentration in the adrenals of dog fetuses was lower than that after birth: the highest concentration was analysed in dogs aged 28 days (1780 +/- 340 micrograms/g) and in cats aged 6 months (1497 +/- 203 micrograms/g). The significance of ascorbic acid for the development of the tissues of carnivores is discussed and compared with the concentration in other species.

  5. The effect of dietary supplementation of vitamins C and E on the α-tocopherol content of muscles, liver and kidney, on the stability of lipids, and on certain meat quality parameters of the longissimus dorsi of rabbits.

    PubMed

    Lo Fiego, D P; Santoro, P; Macchioni, P; Mazzoni, D; Piattoni, F; Tassone, F; De Leonibus, E

    2004-06-01

    The trial was carried out to investigate the effects of adding to the diet of rabbits vitamin E (40; 300; 500 ppm) and C (0; 500 ppm), on vitamin E deposition in the muscles and organs, on the oxidative stability of muscular lipids, and on various meat quality characteristics. The α-tocopherol content in muscles and organs was roughly doubled by feeding the highest levels of vitamin E; it was also increased by giving 500 ppm of vitamin C, but only in those muscles of rabbits receiving 40 ppm of vitamin E. The α-tocopherol content in tissues was negatively correlated with TBARS values of the longissimus dorsi (LD) at days 6 and 8 post mortem (p.m.). Five hundred parts per million (ppm) of vitamin C increased lipid stability of the LD at both 6 and 8 days p.m., though its effect was significant only with 40 ppm of vitamin E. Moreover, 500 ppm of vitamin C resulted in the lowest L(*) and highest pH values at all p.m. times, when the dietary vitamin E was equal to 40 ppm, and in the highest L(*) and lowest pH values when the vitamin E was equal to 300 ppm. Conversely, weight losses of the LD were the lowest, at days 6 and 8 p.m., in the group fed the highest levels of both vitamins.

  6. The effect of chilled conditioning at 4°C on selected water and lipid-soluble flavor precursors in Bison bison longissimus dorsi muscle and their impact on sensory characteristics.

    PubMed

    Williamson, Jennifer; Ryland, Donna; Suh, Miyoung; Aliani, Michel

    2014-01-01

    Water and lipid-soluble flavor precursors were monitored using chromatography methods in the longissimus dorsi (LD) muscle of six grain-fed Bison bison, stored at 4°C for 2, 4, 8, 15 and 21 days in order to investigate their potential impact on sensory attributes of cooked bison meat. While pH and lipid-soluble compounds remained mostly unchanged, several changes in water-soluble compounds were observed. The breakdown of inosine-5'-monophosphate (IMP) led to increases in inosine, hypoxanthine and ribose (7-fold). Non-polar amino acids including valine, leucine and phenylalanine showed the most significant increases over 21 days. Trained panelists (n=8) found a significant increase at day 15 in vinegary/sour aroma, tenderness and juiciness, while chewiness and connective tissue significantly decreased. Although, most flavor attributes were undetectable, partial least squares (PLS) analysis revealed most water-soluble precursors were positively correlated with extended conditioning as well as beef and oily/fatty flavors. Quantitative changes observed in flavor precursors may be responsible for some sensory attributes developed during the heating process.

  7. Primary cutaneous adenoid carcinoma of the scalp.

    PubMed

    Keck, Meike; Ueberreiter, Klaus; Tanzella, Ursula; Doll, Dietrich; Krapohl, Björn Dirk

    2012-01-01

    Primary adenoid carcinoma are rare skin tumors. We present a 75-year-old female with this primary cutaneous tumor of the scalp with additional bone involvement. Wide scalp excision with bone enclosure, latissimus-dorsi-free-flap defect overage, and subsequent radiation slowed down the disease but could not prevent further skull infiltration.

  8. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    PubMed

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.

  9. Dynamic aortomyoplasty: clinical experience.

    PubMed

    Trainini, J; Barisani, J; Elencwajg, B; Cabrera Fischer, E; Ahuad, A; Roncoroni, A

    1997-08-01

    Dynamic aortomyoplasty has been the subject of experimentation for the treatment of congestive heart failure during the last few years. This method consists of diastolic counterpulsation of the ascending aorta through the stimulation of the latissimus dorsi wrapped around it. This report describes the results of aortomyoplasty in a patient with dilated cardiomyopathy resulting from Chagas' disease and contraindications for heart transplantation or cardiomyoplasty.

  10. Growth potential and left ventricular diastolic function in cardiomyoplasty.

    PubMed

    Misawa, Y; Fuse, K; Hasegawa, T; Konishi, H

    1998-05-01

    Dynamic cardiomyoplasty is an experimental operation for advanced heart failure. Current clinical results bring the possibility of its application to children. This study was designed to obtain information about the relationship between cardiomyoplasty and growth of the heart. Six beagles, 9 to 10 weeks old, underwent cardiomyoplasty without electric stimulation (cardiomyoplasty group), and another 5 beagles underwent median sternotomy and pericardiotomy (control group). Six months later, weights of hearts, wrapped latissimus dorsi muscles, and unwrapped right latissimus dorsi muscles and pressure-volume relationships were obtained. Wrapped latissimus dorsi muscles weighed 33 +/- 3 g (mean +/- standard deviation), and unwrapped muscles weighed 68 +/- 5 g. The heart weight was 82 +/- 3 g in the cardiomyoplasty group and 89 +/- 7 g in the control group. Left ventricular maximum elastance was 3.8 +/- 0.8 mm Hg/mL in the cardiomyoplasty group and 3.9 +/- 0.9 mm Hg/mL in the control group. End-diastolic pressure versus end-diastolic volume ratios were 0.52 +/- 0.03 and 0.54 +/- 0.05, respectively. Pathologic examination showed fat infiltration and muscle fiber atrophy in the cardiomyoplasty group. The wrapped latissimus dorsi muscle flaps were growing and the diastolic function was not impaired. This indicates a potentially safe clinical application of dynamic cardiomyoplasty for children.

  11. Post-mortem activity of the glycogen debranching enzyme and change in the glycogen pools in porcine M. longissimus dorsi from carriers and non-carriers of the RN(-) gene.

    PubMed

    Ylä-Ajos, Maria S K; Lindahl, Gunilla; Young, Jette F; Theil, Peter K; Puolanne, Eero; Enfält, Ann-Charlotte; Andersen, Henrik J; Oksbjerg, Niels

    2007-01-01

    Glycogen debranching enzyme (GDE) is together with glycogen phosphorylase responsible for the degradation of glycogen. The present study compares the post-mortem activity of GDE and breakdown of the glycogen pools in M. longissimus dorsi of RN(-) carrier pigs and in wild type animals. The activity of GDE (n=14) and pH (n=20) was measured 0.5, 3, 5, 24 and 48h post-mortem. The change in pro-glycogen and in macro-glycogen content (n=20) was followed until 216h post-mortem and the transcription level of GDE, glycogenin and glycogen synthase m-RNA (n=19) were measured 0.5h post-mortem. Both the activity of GDE and the transcription level of GDE were found to be similar in RN(-) carriers and wild type animals shortly after slaughter. However, the activity declined faster in wild type animals compared with RN(-) carriers with increasing time post-mortem. The contents of both pro-glycogen and macro-glycogen were higher in RN(-) carriers compared with wild type animals, and further, the proportion of macro-glycogen was higher in RN(-) carriers compared with wild type animals. During the post-mortem period, only degradation of pro-glycogen was observed in both genotypes. The decrease in pH was faster and the ultimate pH lower in RN(-) carriers than in wild type animals. It was suggested that the higher GDE activity in the late phase of the post-mortem period in muscles from RN(-) carriers renders the extended pH decrease in these muscles.

  12. Pharmacologic manipulation of the microcirculation in cutaneous and myocutaneous flaps in pigs

    SciTech Connect

    Pang, C.Y.; Neligan, P.C.; Nakatsuka, T.; Sasaki, G.H.

    1985-04-01

    The vascular effects of isoxsuprine, diazoxide, and isoproterenol were studied in arterial buttock flaps and latissimus dorsi myocutaneous flaps in pigs. Capillary blood flow to the skin and muscles of these flaps was measured by the radioactive microsphere (15-mu diameter) technique 6 hours postoperatively under pentobarbital anesthesia. It was observed that isoproterenol, a beta-adrenergic receptor agonist, was not effective in augmentation of skin blood flow in the arterial buttock flaps. However, isoproterenol significantly increased capillary blood flow to the arterialized portion of latissimus dorsi myocutaneous flaps compared with controls. Isoxsuprine and diazoxide (vascular smooth muscle relaxants) significantly (p less than 0.05) increased total capillary blood flow to the skin of arterial buttock flaps and to the skin and muscles of the latissimus dorsi myocutaneous flaps. However, the increase in capillary blood flow occurred mainly in the arterialized portion of these flaps. The capillary blood flow, which was supplied by the small arteries in the distal portion of the arterial buttock and latissimus dorsi flaps, was not increased by treatment with isoxsuprine or diazoxide. Therefore, there was also no increase in the maximum distance of capillary blood flow from the pedicle to the distal end of the flaps. These observations led the authors to hypothesize that different sizes (diameters) of arteries in the skin and muscle have different reactivity (or sensitivity) to vasodilatory drugs. In the present experiment, the large dominant artery of the arterial buttock and latissimus dorsi flaps responded to isoxsuprine or diazoxide (vascular smooth-muscle relaxants), resulting in an increase in blood supply to the capillaries in the proximal portion of the flaps.

  13. A triceps musculocutaneous flap for chest-wall defects

    SciTech Connect

    Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. )

    1990-09-01

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

  14. Acute ischemic preconditioning of skeletal muscle prior to flap elevation augments muscle-flap survival.

    PubMed

    Carroll, C M; Carroll, S M; Overgoor, M L; Tobin, G; Barker, J H

    1997-07-01

    Ischemic preconditioning of the myocardium with repeated brief periods of ischemia and reperfusion prior to prolonged ischemia significantly reduces subsequent myocardial infarction. Following ischemic preconditioning, two "windows of opportunity" (early and late) exist, during which time prolonged ischemia can occur with reduced infarction size. The early window occurs at approximately 4 hours and the late window at 24 hours following ischemic preconditioning of the myocardium. We investigated if ischemic preconditioning of skeletal muscle prior to flap creation improved subsequent flap survival and perfusion immediately or 24 hours following ischemic preconditioning. Currently, no data exist on the utilization of ischemic preconditioning in this fashion. The animal model used was the latissimus dorsi muscle of adult male Sprague-Dawley rats. Animals were assigned to three groups, and the right or left latissimus dorsi muscle was chosen randomly in each animal. Group 1 (n = 12) was the control group, in which the entire latissimus dorsi muscle was elevated acutely without ischemic preconditioning. Group 2 (n = 8) investigated the effects of ischemic preconditioning in the early window. In this group, the latissimus dorsi muscle was elevated immediately following preconditioning. Group 3 (n = 8) investigated the effects of ischemic preconditioning in the late window, with elevation of the latissimus dorsi muscle 24 hours following ischemic preconditioning. The preconditioning regimen used in groups 2 and 3 was two 30-minute episodes of normothermic global ischemia with intervening 10-minute episodes of reperfusion. Latissimus dorsi muscle ischemia was created by occlusion of the thoracodorsal artery and vein and the intercostal perforators, after isolation of the muscle on these vessels. Muscle perfusion was assessed by a laser-Doppler perfusion imager. One week after flap elevation, muscle necrosis was quantified in all groups by means of computer-assisted digital

  15. Free tissue transfer in patients with severe peripheral arterial disease: functional outcome in reconstruction of chronic lower extremity defects.

    PubMed

    Kolbenschlag, Jonas; Hellmich, Susanne; Germann, Günter; Megerle, Kai

    2013-11-01

    Chronic wounds of the lower extremity are difficult to treat, especially in patients with peripheral arterial disease (PAD). This patient population frequently suffers from multiple comorbidities, which further impairs wound healing. Local flaps are often not available, or are insufficient to cover these defects, and limbs are frequently amputated, although they could possibly be salvaged by free tissue transplantation. Although there is a growing evidence that free tissue transfer may be feasible in these patients with otherwise doomed extremities, previous studies have mostly focused on short-term flap survival, but not long-term ambulatory status and independence. Therefore, we investigated the long-term results of limb salvage, ambulatory status, and social independence in patients with PAD who underwent free tissue transfer for chronic wounds of the lower extremities.In this study we retrospectively reviewed 38 patients who underwent free tissue transfer because of nontraumatic, chronic wounds of the lower extremities at our institution. All patients suffered from a nontraumatic occlusion of at least one major lower leg artery verified by angiography. After a mean time period of 34 months we assessed flap survival and limb preservation as well as pre- and postoperative ambulatory status and social independence. A subgroup of 14 patients with a "single-vessel-leg" was evaluated separately.It was observed that anterolateral thigh and latissimus dorsi musculocutaneous flaps were most often used to cover the defects. Overall 29 out of the 38 flaps healed completely (9 flap failures) and 34 extremities were salvaged, including 12 out of 14 single-vessel-legs. One patient had to be amputated despite a vital free flap because of persistent calcaneal osteomyelitis. After failure of free tissue transfer, six extremities could still be salvaged by secondary procedures (two secondary free flaps, two local flaps, and two skin grafts). Total 22 out of 34 patients with

  16. An unusually medial axillary arch muscle.

    PubMed Central

    Dharap, A

    1994-01-01

    In the left upper limb of an adult male cadaver a triangular muscular slip, 3.5 cm long and 2.5 cm wide, arose from the lower border of latissimus dorsi just proximal to its tendon of insertion. It was inserted by a slender 6 cm long tendon mainly into the coracoid process of the scapula. Three short fibrous strands radiated from this slender tendon to gain attachments to pectoralis minor and the common tendon of origin of the short head of biceps brachii and coracobrachialis. In addition 2 flat tendinous bands attached the margin of this muscular slip to teres major. The thoracodorsal nerve entered the main bulk of latissimus dorsi close to the muscular slip but did not supply a separate branch to the latter. This is an axillary arch muscle in an unusually medial location. Images Fig. 1 Fig. 2 PMID:7928652

  17. Thermal injury in TAPIA breast reconstruction—thermal injury to thoracodorsal artery perforator flap

    PubMed Central

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L.; Sørensen, Jens Ahm

    2017-01-01

    This paper presents two case reports on thermal injury to a breast reconstructed by the TAPIA method. In both cases the injuries were caused by excessive sun exposure. Thermal injury to flaps used in breast reconstruction has previously been described but most commonly in abdominal flaps, which may be due to the relative high frequency of this type of reconstructions. Reports of thermal injury to reconstructions using the Latissimus Dorsi flap are rare. The injuries previously described are most often caused by severe heat exposure. The thoracodorsal artery perforator (TAP)-flap can be used as an alternative to the Latissimus Dorsi flap but it may be more susceptible to thermal insult due to the total denervation, the restricted blood supply and the limited thickness of the flap. Precautions are recommended to avoid this type of injury. PMID:28210561

  18. Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis.

    PubMed

    Kurita, Masakazu; Takushima, Akihiko; Shiraishi, Tomohiro; Kinoshita, Mikio; Ozaki, Mine; Harii, Kiyonori

    2013-07-01

    We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow. To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.

  19. Muscle development in thyroidectomised chickens (Gallus domesticus).

    PubMed

    Moore, G E; Harvey, S; Klandorf, H; Goldspink, G

    1984-08-01

    The metabolic and contractile activity of muscle was determined in immature cockerels made hypothyroid by surgical thyroidectomy at 6 weeks of age. Four weeks after thyroidectomy the activity of Mg2+-activated myofibrillar ATPase and total phosphorylase was reduced in the fast-phasic, posterior latissimus dorsi (PLD) and scapulotriceps (ST) muscles. The activities of these enzymes were unaffected in the slow-tonic, anterior latissimus dorsi (ALD) muscle. Thyroidectomy had no effect on length of the muscles studied but reduced the weight of the ALD and ST muscles. These results suggest that hypothyroidism results in a "slowing down" of fast-phasic muscles, although it does not affect the activity of slow-tonic muscles.

  20. Microvascular transplants in head and neck reconstruction: 3D evaluation of volume loss.

    PubMed

    Bittermann, Gido; Thönissen, Philipp; Poxleitner, Philipp; Zimmerer, Ruediger; Vach, Kirstin; Metzger, Marc C

    2015-10-01

    Despite oversized latissimus dorsi free flap reconstruction in the head and neck area, esthetic and functional problems continue to exist due to the well-known occurrence of transplant shrinkage. The purpose of this study was to acquire an estimation of the volume and time of the shrinkage process. The assessment of volume loss was performed using a 3D evaluation of two postoperative CT scans. A retrospective review was conducted on all latissimus dorsi free flap reconstructions performed between 2004 and 2013. Inclusion criteria for the assessment were: resection of an oral carcinoma and microsurgical defect coverage with latissimus dorsi free flap; a first postoperative CT (CT1) performed between 3 weeks and a maximum of 3 months after reconstruction surgery; and an additional CT scan (CT2) performed at least one year postoperatively. The exclusion criterion was surgical intervention in the local area between the acquisition of CT1 and CT2. The effect of adjuvant radiation therapy was considered. Volume determination of the transplant was carried out in CT1 and CT2 by manual segmentation of the graft. Fifteen patients were recruited. 3D evaluation showed an average volume loss of 34.4%. In the consideration of postoperative radiotherapy the volume reduction was 39.2% in patients with radiotherapy and 31.3% in patients without radiotherapy. The reconstruction flap volume required for overcorrection of the surgical defect was investigated. This study indicates that a volume loss of more than 30% could be expected one or more years after latissimus dorsi free flap reconstruction. Clinical trial number DRKS00007534. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. Hypoplasty of the breast due to x-ray irradiation

    SciTech Connect

    Wada, H.; Jinnai, K.; Urabe, H.

    1986-01-01

    We treated five women with hypoplasty of the breast induced by radiation. Only one of these women underwent mammaplasty with the use of a latissimus dorsi muscle flap and prosthesis. Hypoplasty of the breast is considered a result of imprudent utilization of x-ray irradiation of young patients with benign skin diseases. To prevent underdevelopment and hypoplasty, attention must be directed to the risk involved in radiation therapy for benign diseases.

  2. The Gradual Expansion Muscle Flap

    DTIC Science & Technology

    2014-01-01

    Biochem Cytol. 1961;9:493 495. 42. Sola OM, Christensen DL, Martin AW. Hypertrophy and hyperplasia of adult chicken anterior latissimus dorsi muscles ...TECHNICAL TRICK The Gradual Expansion Muscle Flap Michael J. Beltran, MD,* James A. Blair, MD,* Christopher R. Rathbone, PhD,† and Joseph R. Hsu, MD...acute shortening and angulation of the tibia and rotational muscle flap coverage and split thickness skin grafting of the soft tissue defect

  3. Myogenic Growth Factor Present in Skeletal Muscle is Purified by Heparin-Affinity Chromatography

    NASA Astrophysics Data System (ADS)

    Kardami, Elissavet; Spector, Dennis; Strohman, Richard C.

    1985-12-01

    A myogenic growth factor has been purified from a skeletal muscle, the anterior latissimus dorsi, of adult chickens. In the range of 1-10 ng, this factor stimulates DNA synthesis as well as protein and muscle-specific myosin accumulation in myogenic cell cultures. Purification is achieved through binding of the factor to heparin. The factor is distinct from transferrin and works synergistically with transferrin in stimulating myogenesis in vitro.

  4. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation.

    PubMed

    Weitgasser, Laurenz; Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

  5. Complex scalp, skull, and dural defect reconstruction using a turnover "tournedos" myocutaneous free flap.

    PubMed

    Lessard, Lucie; Tahiri, Youssef

    2013-01-01

    The latissimus dorsi flap is one of the most commonly used flaps for calvarial defect reconstruction. In the setting of radiation and/or chronic infection and when skeletal reconstruction of the cranium is not recommended, standard calvarial reconstruction needs to be refined. The standard use of the latissimus dorsi only was associated with potential dead space over the dura, limited skin paddle size, and potential external contour irregularities. In this study, we present our approach to complex calvarial reconstruction with free tissue transfer without bone grafting while avoiding contour deformities in 1 efficient surgical procedure. We propose the "tournedos" turnover de-epithelialized latissimus dorsi flap, which provides stable dermal and subdermal tissue that will not undergo atrophy over time over the dura. To reach an adequate aesthetic result, we used a uniform, unmeshed, thick split-thickness skin graft over the muscular portion of the tournedos flap. Patients who underwent this procedure, from March 1992 to March 2012, at McGill University Health Center and the Montreal Neurological Institute were included. Thirty-three complex microsurgical procedures for oncologic calvarial defect reconstructions were performed from March 1992 to March 2012. Among them, 6 patients benefited from the tournedos procedure. The average age was 74 years. Scalp defects sizes ranged from 4 × 10 to 16 × 18 cm (40-288 cm). All latissimus dorsi flap donor sites were closed primarily. Patients kept their donor-site drains for approximately 18 days (±5 days). One patient developed a seroma at the donor site after drain removal that was treated conservatively. All patients were satisfied with their reconstructions, and no secondary procedures were necessary. We present our most recent case with good photographic documentation. Our approach using the tournedos turnover de-epithelialized free flap provides durable and stable coverage for irradiated and/or previously infected

  6. [Thoracodorsal pedicled perforator flap for chest wall and breast reconstruction in children: Illustration with two clinical cases].

    PubMed

    Minetti, C; Colson, T; Gisquet, H; Pujo, J; Brix, M; Simon, E

    2014-02-01

    Perforator flaps represent a new approach in reconstructive surgery including the thoracodorsal perforator flap. It can be used as a free or pedicled tissue transfer. By exposing two clinical cases, we demonstrate that this flap is an interesting option for children and adolescents chest wall skin coverage with less morbidity compared to myocutaneous latissimus dorsi flap. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  7. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation

    PubMed Central

    Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction. PMID:28194351

  8. [EFFECTIVENESS OF CONTRALATERAL C7 NERVE ROOT AND MULTIPLE NERVES TRANSFER FOR TREATMENT OF BRACHIAL PLEXUS ROOT AVULSION].

    PubMed

    Wei, Wang; Alimujiang-Abulaiti; Tuerxunjiang-Dadihan; Meihua, Shen; Yafei, Liu; Chunxiao, Yuan; Aihemaitijiang-Yusufu

    2014-06-01

    shoulder abduction was 0°. The muscle strength of elbow/biceps was M3 or more than M3 in 9 cases, was M1-M2 in 8 cases, and was M0 in 6 cases; the muscle strength of flexor wrist or finger was M3 or more than M3 in 7 cases, was M1-M2 in 11 cases, and was M0 in 5 cases. Median nerve sensory recovery was S3 or more than S3 in 11 cases, was S1-S2 in 7 cases, and was S0 in 5 cases. After 3 years, affected limb had locomotor activity in 11 patients, affected limb had activities driven by the contralateral latissimus dorsi muscle contraction in 12 patients. Contralateral C7 nerve root and multiple nerves transfer is a good method to treat brachial plexus root avulsion.

  9. Salbutamol and chronic low-frequency stimulation of canine skeletal muscle.

    PubMed Central

    Hu, P; Zhang, K M; Feher, J J; Wang, S W; Wright, L D; Wechsler, A S; Spratt, J A; Briggs, F N

    1996-01-01

    1. The effect of simultaneous application of chronic muscle stimulation and salbutamol on the expression of mRNAs and proteins normally expressed by fast- or slow-twitch fibres was followed and the effects of changes in protein expression on mechanical performance were evaluated. Chronic low-frequency stimulation increased the myosin heavy chain (HC)-I level in the canine latissimus dorsi muscle and simultaneous administration of salbutamol partially blocked this change. Associated with the increase in HC-I level was a decrease in the velocity of shortening at zero load, VMAX. The change in VMAX was partially blocked by salbutamol. 2. Chronic low-frequency stimulation increased the levels of slow-twitch cardiac isoform sarco-/endoplasmic reticulum Ca(2+)-ATPase (SERCA2a) and phospholamban mRNA, and SERCA2a and phospholamban protein expression. These changes were associated with an increase in time-to-peak tension and a decrease in fusion frequency. Simultaneous administration of salbutamol blocked these changes in protein expression and muscle mechanics. Chronic stimulation of latissimus dorsi decreased the levels of the fast-twitch isoform of sarco-/endoplasmic reticulum Ca(2+)-ATPase (SERCA1a) and increased SERCA2a protein expression and decreased calcium uptake rate by muscle homogenates. These changes were blocked by salbutamol. 3. The loss of latissimus dorsi muscle weight by chronic stimulation was partially blocked by salbutamol. Images Figure 1 Figure 4 PMID:8910210

  10. Scalp reconstruction by microvascular free tissue transfer

    SciTech Connect

    Furnas, H.; Lineaweaver, W.C.; Alpert, B.S. )

    1990-05-01

    We report on a series of patients with scalp defects who have been treated with a variety of free flaps, spanning the era of microvascular free tissue transfer from its incipient stages to the present. Between 1971 and 1987, 18 patients underwent scalp reconstruction with 21 free flaps: 11 latissimus dorsi, 3 scalp transfers between identical twins, 3 groin, one combined latissimus dorsi and serratus anterior, two serratus anterior, and one omentum. These flaps were used to cover scalp defects resulting from burns, trauma, radiation, and tumors in patients ranging from 7 to 79 years of age. Follow-up has ranged from 3 weeks to 7 years. All of our flaps survived and covered complex defects, many of which had failed more conservative attempts at cover. One patient received radiation therapy to his flap without unfavorable sequelae. This experience began with a pioneering omental flap and includes cutaneous and muscle flaps. The latissimus dorsi is our first choice for free flap reconstruction of extensive, complicated scalp wounds because of its large size, predictable blood supply, ease of harvesting, and provision of excellent vascularity to compromised beds.

  11. Efficacy of a skeletal muscle-powered dynamic patch: Part 2. Right ventricular assistance.

    PubMed

    Watanabe, G; Misaki, T; Takahashi, M; Ohtake, H; Tsunezuka, Y; Wada, M; Watanabe, Y

    1995-02-01

    The purpose of this study was to assess the feasibility of using a skeletal muscle-powered dynamic patch to assist the failing right ventricle. Seven adult mongrel dogs were used in the study. The proximal portion of the left latissimus dorsi muscle was harvested and reattached to the actuator to serve as a skeletal muscle energy convertor. The right ventricular free wall was fully excised and the dynamic patch was implanted under cardiopulmonary bypass. After weaning from cardiopulmonary bypass, the latissimus dorsi muscle was stimulated using a burst frequency of 33 Hz, a burst duration of 200 ms, and 1:2 synchronous mode stimulation with the native R wave. Latissimus dorsi muscle stimulation increased systolic aortic pressure (78 versus 91 mm Hg; p < 0.01), mean aortic pressure (56 versus 62 mm Hg; p < 0.05), aortic blood flow (0.73 versus 0.97 mL; p < 0.01), and systolic right ventricular pressure (41 versus 56 mm Hg; p < 0.01). The mean right atrial pressure decreased from 14 to 9.6 mm Hg (p < 0.01). Our results demonstrate that the use of a right ventricular dynamic patch powered by a skeletal muscle linear-type actuator can not only function as a right ventricular free wall substitute but also lead to the augmentation of right ventricular and global cardiac function.

  12. A reliable approach to the closure of large acquired midline defects of the back

    SciTech Connect

    Casas, L.A.; Lewis, V.L. Jr. )

    1989-10-01

    A systematic regionalized approach for the reconstruction of acquired thoracic and lumbar midline defects of the back is described. Twenty-three patients with wounds resulting from pressure necrosis, radiation injury, and postoperative wound infection and dehiscence were successfully reconstructed. The latissimus dorsi, trapezius, gluteus maximus, and paraspinous muscles are utilized individually or in combination as advancement, rotation, island, unipedicle, turnover, or bipedicle flaps. All flaps are designed so that their vascular pedicles are out of the field of injury. After thorough debridement, large, deep wounds are closed with two layers of muscle, while smaller, more superficial wounds are reconstructed with one layer. The trapezius muscle is utilized in the high thoracic area for the deep wound layer, while the paraspinous muscle is used for this layer in the thoracic and lumbar regions. Superficial layer and small wounds in the high thoracic area are reconstructed with either latissimus dorsi or trapezius muscle. Corresponding wounds in the thoracic and lumbar areas are closed with latissimus dorsi muscle alone or in combination with gluteus maximus muscle. The rationale for systematic regionalized reconstruction of acquired midline back wounds is described.

  13. Effect of the upper limbs muscles activity on the mechanical energy gain in pole vaulting.

    PubMed

    Frère, Julien; Göpfert, Beat; Slawinski, Jean; Tourny-chollet, Claire

    2012-04-01

    The shoulder muscles are highly solicited in pole vaulting and may afford energy gain. The objective of this study was to determine the bilateral muscle activity of the upper-limbs to explain the actions performed by the vaulter to bend the pole and store elastic energy. Seven experienced athletes performed 5-10 vaults which were recorded using two video cameras (50Hz). The mechanical energy of the centre of gravity (CG) was computed, while surface electromyographic (EMG) profiles were recorded from 5 muscles bilateral: deltoideus, infraspinatus, biceps brachii, triceps, and latissimus dorsi muscles. The level of intensity from EMG profile was retained in four sub phases between take-off (TO1) and complete pole straightening (PS). The athletes had a mean mechanical energy gain of 22% throughout the pole vault, while the intensities of deltoideus, biceps brachii, and latissimus dorsi muscles were sub phases-dependent (p<0.05). Stabilizing the glenohumeral joint (increase of deltoideus and biceps brachii activity) and applying a pole bending torque (increase of latissimus dorsi activity) required specific muscle activation. The gain in mechanical energy of the vaulter could be linked to an increase in muscle activation, especially from latissimusdorsi muscles. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Elastofibroma dorsi: The clunking tumour that need not cause alarm

    PubMed Central

    Smith, HG; Hannay, JAF; Thway, K; Messiou, C; Smith, MJF; Strauss, DC; Hayes, AJ

    2016-01-01

    Introduction Elastofibromas are rare, pseudo-tumours arising at the inferior pole of the scapula that have a characteristic presentation. Due to their tissue of origin and size, they may often be mistaken for soft tissue sarcomas. We present the management of patients diagnosed with elastofibroma at a single institution. Methods Patients diagnosed with elastofibroma between January 1995 and January 2015 were identified from a prospectively maintained histopathology database. Electronic patient records, imaging and pathology reports were retrieved and reviewed. Results Thirty seven patients were identified, with a median age of 66 years and a male-to-female ratio of 1:1.6. All tumours occurred in the characteristic subscapular location. The median maximum tumour diameter was 8.2cm. A synchronous contralateral lesion (15.8%) was found in six patients. Cross-sectional imaging was performed in 29 patients, with magnetic resonance imaging the most common modality (59.5%). Diagnosis was confirmed with percutaneous biopsy in all but one patient, who proceeded directly to surgery. Eighteen patients were managed non-operatively; 19 opted for surgical excision due to significant symptoms. Excision was performed in a marginal fashion and, at a median follow-up of 5 months, no functional impairment or local recurrences were observed. Conclusions Soft tissue masses greater than 5cm in diameter should prompt the clinician to exclude soft tissue sarcoma. The diagnosis of elastofibroma may be alluded to by its typical presentation and can be confirmed by percutaneous biopsy. After excluding malignancy, these lesions can be safely managed non-operatively, with surgery reserved for symptomatic patients. PMID:26890837

  15. Negative-pressure wound therapy and early pedicle flap reconstruction of the chest wall after epirubicin extravasation.

    PubMed

    Papadakis, Marios; Rahmanian-Schwarz, Afshin; Bednarek, Marzena; Arafkas, Mohamed; Holschneider, Philipp; Hübner, Gunnar

    2017-05-15

    Accidental extravasation is a serious iatrogenic injury among patients receiving anthracycline-containing chemotherapy. The aim of this work is to present a combination therapy for chest wall reconstruction following epirubicin extravasation. Herein, we report a 68-year-old woman with massive soft tissue necrosis of the anterolateral chest wall after epirubicin extravasation from a port implanted in the subclavicular area. The necrotic tissue was resected, the port was removed, and negative-pressure wound therapy was applied. Three weeks later, a latissimus dorsi pedicle flap was successfully used to cover the defect. To the best of the authors' knowledge, this is the first report of a strategy comprising the combination of negative-pressure wound therapy and a latissimus pedicle flap for reconstruction of the chest wall after soft tissue necrosis following epirubicin extravasation.

  16. Clinical analysis of 113 patients with Poland syndrome.

    PubMed

    Yiyit, Nurettin; Işıtmangil, Turgut; Öksüz, Sinan

    2015-03-01

    Poland syndrome is a rare congenital anomaly characterized by the partial or complete absence of pectoral muscles, varying thoracic deformities, and hand anomalies. To date, many variants of this syndrome and its accompanying anomalies have been reported. In our clinic, 113 patients were diagnosed with Poland syndrome between 1990 and 2014. A latissimus dorsi muscle transfer was performed on 6 of these patients. Out of 113 patients, 63 (55.7%) were diagnosed with the syndrome on the right side, 42 (37.1%) were diagnosed on the left side, and 8 (7%) had a bilateral diagnosis. The partial or complete absence of the pectoralis major muscle was detected in all patients. Although 81 (71.6%) patients had a complete absence of the pectoralis major muscle, 32 (28.3%) were lacking only the sternocostal head of the muscle. In the analyzed cases, Poland syndrome was also found to be accompanied by specific anomalies. The most common anomaly accompanying Poland syndrome in these patients was Sprengel deformity, seen in 18 patients. Symmetry and stabilization of the chest wall were performed in 6 patients through transfer of the latissimus dorsi muscle. Poland syndrome is a rare congenital anomaly, which has several variants and accompanying anomalies. The absence of several muscles in addition to the pectoral muscle can be seen in patients with Poland syndrome. Sprengel deformity is the most common accompanying anomaly. Several surgical procedures have been reported for the syndrome; for example, transposing the latissimus dorsi muscle is an effective procedure in terms of stabilizing the chest wall and providing optimum symmetric body appearance. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Recovery of emotional smiling function in free-flap facial reanimation.

    PubMed

    Biglioli, Federico; Colombo, Valeria; Tarabbia, Filippo; Autelitano, Luca; Rabbiosi, Dimitri; Colletti, Giacomo; Giovanditto, Federica; Battista, Valeria; Frigerio, Alice

    2012-10-01

    Long-standing unilateral facial palsy is treated primarily with free-flap surgery using the masseteric or contralateral facial nerve as a motor source. The use of a gracilis muscle flap innervated by the masseteric nerve restores the smiling function, without obtaining spontaneity. Because emotional smiling is an important factor in facial reanimation, the facial nerve must serve as the motor source to achieve this fundamental target. From October 1998 to October 2009, 50 patients affected by long-standing unilateral facial paralysis underwent single-stage free-flap reanimation procedures to recover smiling function. A latissimus dorsi flap innervated by the contralateral facial nerve was transplanted in 40 patients, and a gracilis muscle flap innervated by the masseteric nerve in 10 patients. All patients underwent a clinical examination that analyzed voluntary and spontaneous smiling. All patients who received a latissimus dorsi flap innervated by the contralateral facial nerve and recovered muscle function (92.5%) showed voluntary and spontaneous smiling abilities. All patients who received a gracilis free flap innervated by the masseteric nerve recovered function, but only 1 (10%) showed occasional spontaneous flap activation. During those rare activations, much less movement was visible on the operated side than when the patient was asked to smile voluntarily. The masseteric nerve is a powerful motor source that guarantees free voluntary gracilis muscle activation; however, it does not guarantee any spontaneous smiling. Single-stage procedures that use a latissimus dorsi flap innervated by the contralateral facial nerve have a lower success rate and obtain less movement; however, spontaneous smiling is always observed. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Arm position influences the activation patterns of trunk muscles during trunk range-of-motion movements.

    PubMed

    Siu, Aaron; Schinkel-Ivy, Alison; Drake, Janessa Dm

    2016-10-01

    To understand the activation patterns of the trunk musculature, it is also important to consider the implications of adjacent structures such as the upper limbs, and the muscles that act to move the arms. This study investigated the effects of arm positions on the activation patterns and co-activation of the trunk musculature and muscles that move the arm during trunk range-of-motion movements (maximum trunk axial twist, flexion, and lateral bend). Fifteen males and fifteen females, asymptomatic for low back pain, performed maximum trunk range-of-motion movements, with three arm positions for axial twist (loose, crossed, abducted) and two positions for flexion and lateral bend (loose, crossed). Electromyographical data were collected for eight muscles bilaterally, and activation signals were cross-correlated between trunk muscles and the muscles that move the arms (upper trapezius, latissimus dorsi). Results revealed consistently greater muscle co-activation (higher cross-correlation coefficients) between the trunk muscles and upper trapezius for the abducted arm position during maximum trunk axial twist, while results for the latissimus dorsi-trunk pairings were more dependent on the specific trunk muscles (either abdominal or back) and latissimus dorsi muscle (either right or left side), as well as the range-of-motion movement. The findings of this study contribute to the understanding of interactions between the upper limbs and trunk, and highlight the influence of arm positions on the trunk musculature. In addition, the comparison of the present results to those of individuals with back or shoulder conditions may ultimately aid in elucidating underlying mechanisms or contributing factors to those conditions.

  19. A compressive type skeletal muscle pump as a biomechanical energy source.

    PubMed

    Mizuhara, H; Oda, T; Koshiji, T; Ikeda, T; Nishimura, K; Nomoto, S; Matsuda, K; Tsutsui, N; Kanda, K; Ban, T

    1996-01-01

    The purpose of this study was to assess the applicability of the conditioned latissimus dorsi muscle as an energy source for circulatory assist devices. The authors developed a pneumatic chamber as a muscle actuator. The pneumatic chamber placed between latissimus dorsi muscle and chest wall was compressed by the burst stimulated muscle and, thereby, converted muscle contractile power into pneumatic pressure. The authors report the performance of the implanted pneumatic chamber at a chronic phase, and the capability of the conditioned muscle in situ as an energy source for circulatory assist devices. Six adult mongrel dogs were used. At the first operation, a pacemaker for muscle conditioning and the pneumatic chamber were implanted. After 12 weeks of muscle conditioning, the performance of the pneumatic chamber with conditioned muscle was evaluated. The pressure generating capability of a chamber buried in fibrous adhesions was reduced to approximately 65% of that of a chamber without adhesions. The stroke volume and stroke work of the assist device driven by the developed pneumatic pressure were measured. The maximum stroke work of the circulatory assist was greater than the stroke work of the right ventricle, but less than that of the left ventricle. In respect to stroke volume, the pneumatic chamber could drive the circulatory assist device against not only a pulmonary range of afterload, but also a systemic range of afterload, when high pre load was available. These results indicate that the compressive skeletal muscle pump with conditioned latissimus dorsi muscle generates acceptable hemodynamic work for right ventricular bypass or aortic counterpulsation. In the long-term, the interface between tissue and actuator is the major obstacle to developing a muscle powered assist device.

  20. [Anatomic changes after radical surgery and reconstruction with pedunculated or revascularized flaps in advanced head and neck tumors: computerized tomography and magnetic resonance findings].

    PubMed

    Osti, M F; Scattoni Padovan, F; Ricciardi, D; De Angelis D'Ossat, M; Sbarbati, S; Pirolli, C; Maurizi Enrici, R; Anaveri, G

    1997-04-01

    January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps wer used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The postoperative scar around the flap exhibited soft-tissue density with slight post-contrast enhancement at CT and slightly hypodense on T2-weighted MR images. Post-contrast CT and MRI showed slight scar enhancement with no signal changes in the fatty component. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened layers with both imaging methods. Temporal and latissimus dorsi flaps are made basically of muscular tissue, fatty tissue and occasionally skin (used to repair a mucosal defect): consequently, CT showed a structure with mostly parenchymal density in all cases and MRI depicted intermediate signal intensity. MRI was useful to detect 12 revascularized jejunal or radial flaps thanks to its higher contrast resolution and multiplanar capabilities showing even such thin structures as these flaps. Moreover, MRI permitted to study skull base reconstruction with revascularized (latissimus dorsi) flaps in 5 of our patients.

  1. [Rhabdomyolysis after lifting IKEA bags in a man using sertraline].

    PubMed

    Kummen, Ingvild; Jensen, Thomas Giver

    2016-12-12

    We present a case of a 28-year-old male, using sertraline, who experienced progressive oedema in both upper extremities after having lifted two IKEA bags weighing 20 kg each from his car up to the third floor. Blood creatine kinase (CK) level was measured 5,260 U/l, and the patient was admitted for oral rehydration with the diagnosis rhabdomyolysis. The MRI showed swelling in the triceps muscles and latissimus dorsi muscles resulting in compression of the brachial vein. We discuss the pathomechanism behind the increased CK level and the swelling, and the possible effect sertraline may have had on the development of rhabdomyolysis.

  2. How I do it: Simple and effortless approach to identify thoracodorsal nerve on axillary clearance procedure

    PubMed Central

    Zin, T; Maw, M; Oo, SM; Pai, DR; Paijan, RB; Kyi, M

    2012-01-01

    Breast cancer surgery frequently involves an axillary clearance procedure for nodal metastases. Injury to the thoracodorsal nerve is one of the complications related to the axillary dissection. The thoracodorsal nerve innervates the latissimus dorsi muscle which facilitates in certain movements of the arm. Moreover, it can be used as a nerve graft in long thoracic nerve injury whether in trauma or surgery. Understanding the anatomy structures and good surgical technique in the axillary clearance procedure can identify and prevent such an injury to the thoracodorsal nerve. Here, we demonstrate a simple and effortless technique for identification of the thoracodorsal nerve during axillary surgery. PMID:22675404

  3. Lessons in the management of post-operative tension pneumocephalus complicating transcranial resection of advanced cutaneous tumours with free flap reconstruction.

    PubMed

    Swan, Marc C; Scholz, Anna F M; Pretorius, Pieter M; Johnson, David; Martinez-Devesa, Pablo; Wall, Steven A

    2013-12-01

    Tension pneumocephalus is a rare, but potentially life-threatening complication of transcranial surgery. Whilst commonly described in the field of neurosurgery, little has been published in the context of craniofacial surgery. We describe two cases of post-operative extradural tension pneumocephalus occurring following free myocutaneous latissimus dorsi flap reconstruction of anterior cranial defects following extirpation of advanced recurrent skin carcinomas. These cases illustrate the variation in clinical presentation of this condition, the importance of prompt recognition, urgent radiological investigation and timely decompression, and potential management strategies for minimising the risk of recurrent symptoms. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Reconstruction of the breast: where do we fall short? An evolution of ideas.

    PubMed

    Vasconez, L O; Grotting, J C; Calderon, W; Mathes, S J

    1984-07-01

    We have analyzed our 5 year experience with 153 breast reconstructions. There were 83 latissimus dorsi reconstructions, 16 simple silicone implant insertions, 21 transverse rectus abdominus myocutaneous flaps, and 33 reconstructions using a variety of other methods. The rate of postoperative complications was 24 percent. The most common shortcoming was the inability to obtain symmetry with the other breast. Persistent problems included inability to fill the subclavicular hollow or the superior con-cavity due to partial atrophy of the pectoralis major muscle, and particularly, the lack of projection and ptosis in the reconstructed breast.

  5. Primary maxillary reconstruction after radical maxillectomy using a combined free flap and secondary dynamic suspension.

    PubMed

    Yoza, S; Gunji, H; Ono, I

    1997-01-01

    We report a case of maxillary reconstruction aimed at optimizing facial contour, oral function, and facial animation after radical maxillectomy. In the first stage, using combined latissimus dorsi serratus anterior flaps attached with ribs, we performed a three-dimensional restoration for midface defects. In the second stage, we performed dynamic reconstruction of the nasolabial fold and upper lip using a temporal muscle transposition. As a result, the upper lip was able to be elevated as much as 10 mm when the patient clenched his teeth, and the outcome was judged to be both aesthetically and functionally satisfactory.

  6. [Immediate breast reconstruction for breast cancer].

    PubMed

    Yamamoto, Daigo; Tanaka, Yoshihito; Tsubota, Yu; Sueoka, Noriko; Endo, Kayoko; Ogura, Tsunetaka; Nagumo, Yoshinori; Kwon, A-Hon

    2014-11-01

    We performed immediate breast reconstruction after nipple-sparing mastectomy or skin-sparing mastectomy and evaluated the reconstruction procedure, cosmesis, and complications. Among the 30 patients included in the study, 6 received latissimus dorsi flaps, 1 received a transverse rectus abdominis myocutaneous flap, 7 received deep inferior epigastric perforator flaps, 1 received an implant, and 15 received tissue expanders. In addition, the results were excellent in 25 patients, good in 3 patients, and poor in 2 patients. As the number of patients with breast cancer is increasing, the demand for breast reconstruction will increase. Therefore, it is essential to choose an appropriate method of breast reconstruction for each case.

  7. [Operative treatment of abduction and lateral rotation limitation of shoulder in obstetric brachial plexus palsy].

    PubMed

    Jin, Guoqiang; Shi, Qilin

    2010-04-01

    To study the treatment method and effect of abduction and lateral rotation limitation of the shoulder in obstetric brachial plexus palsy (OBPP). From February 2005 to August 2008, 11 patients with abduction and lateral rotation limitation of the shoulder in OBPP were treated with dissection of the origin of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. Among them, there were 6 males and 5 females with a mean age of 6 years (1-15 years). The main clinical manifestations showed adduction, internal rotation contracture deformity of shoulder, limited active and passive external rotation and severely restricted active abduction of shoulder. The passive abduction was more than 90 degrees. According to Gilbert grading, there were 7 cases of grade 1 and 4 cases of grade 2. Based on Mallet score systems, the scores were 5 points in 3 cases, 6 points in 3 cases, and 7 points in 5 cases. The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi all reached 3-4 grades. One patient developed postoperative hematoma, wound healed after symptomatic management. Other patients achieved incision healing by first intention. All patients were followed up for 12 to 37 months (17 months on average). The active abduction and external rotation of the shoulder joints recovered obviously. The Gilbert grading were grade 2 in 1 case, grade 3 in 1 case, and grade 4 in 9 cases; the Mallet scores were 10 points in 1 case, 11 points in 2 cases, 12 points in 4 cases, 13 points in 3 cases, and 14 points in 1 case; showing significant differences when compared with those before operation (P < 0.01). The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi increased to 4-5 grades. The dissection of the origin of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of

  8. Ultrasound-Guided Serratus Anterior Plane Block in Breast Reconstruction Surgery.

    PubMed

    Khemka, Rakhi; Chakraborty, Arunangshu; Ahmed, Rosina; Datta, Taniya; Agarwal, Sanjit

    2016-05-01

    Pecs block and its variations have been used for various breast surgeries. We describe 2 cases of mastectomy and breast reconstruction by latissimus dorsi (LD) flap where regional analgesia was provided by a combination of ultrasound-guided Pecs-I block and serratus anterior plane block, a recently described technique in which local anesthetic is deposited in the plane between the LD and serratus anterior muscle. This resulted in excellent intraoperative and postoperative analgesia and a minimum of systemic analgesics. The described technique is safe to administer and provides good analgesia for breast reconstruction surgery by LD flap.

  9. [Wide resection of chest wall for intramuscular lipoma in serratus anterior muscle reconstructed by autologous tissue;report of a case].

    PubMed

    Mizuno, Kiyomichi; Urabe, Norikazu; Nakatsuka, Kazuhiko; Ishikawa, Kayoko; Eguchi, Masanobu

    2015-02-01

    A 60-years-old man with a right lateral chest wall mass visited our hospital. There was a mass of 50×45 mm on the 5th rib. The mild atypical cells were detected by the percutaneous needle biopsy, and the tumor was resected with the chest wall of which detect was reconstructed with fascia lata and latissimus dorsi muscle cutaneous flap. Pathological diagnosis was lipoma in the serratus anterior muscle. The postoperative course was uneventful without paradoxical respiration and surgical site infection. Since intramuscular lipoma is very rare and is reported to have a risk of recurrence, careful observation is necessary.

  10. Middle lobe preserving right lower lobectomy with a serratus anterior hammock flap in a patient with previous right upper lobectomy.

    PubMed

    Abe, Jiro; Takahashi, Satomi; Nakagawa, Takayuki; Tsukidate, Hisakatsu

    2016-03-01

    Increasingly, many patients are diagnosed with a second lung cancer after curative thoracotomy. It is very difficult to manage such patients surgically due to the significant loss of pulmonary function. Especially on the right side, avoiding a completion pneumonectomy may contribute to reducing postoperative functional loss and surgical complications as well as the morbidity of post-pneumonectomy syndrome. A technique is needed to prevent torsion of the preserved middle lobe. Following recently published cases utilizing a latissimus dorsi muscle flap, in this case report, we describe the use of the serratus anterior muscle flap as an alternative.

  11. Underwater Near-Infrared Spectroscopy: Muscle Oxygen Changes in the Upper and Lower Extremities in Club Level Swimmers and Triathletes.

    PubMed

    Jones, B; Cooper, C E

    2016-01-01

    To date, measurements of oxygen status during swim exercise have focused upon systemic aerobic capacity. The development of a portable, waterproof NIRS device makes possible a local measurement of muscle hemodynamics and oxygenation that could provide a novel insight into the physiological changes that occur during swim exercise. The purpose of this study was to observe changes in muscle oxygenation in the vastus lateralis (VL) and latissimus dorsi (LD) of club level swimmers and triathletes. Ten subjects, five club level swimmers and five club level triathletes (three men and seven women) were used for assessment. Swim group; mean±SD=age 21.2±1.6 years; height 170.6±7.5 cm; weight 62.8±6.9 kg; vastus lateralis skin fold 13.8±5.6 mm; latissimus dorsi skin fold 12.6±3.7. Triathlete group; mean±SD=age 44.0±10.5 years; height 171.6±7.0 cm; weight 68.6±12.7 kg; vastus lateralis skin fold 11.8±3.5 mm; latissimus dorsi skin fold 11.2±3.1. All subjects completed a maximal 200 m freestyle swim, with the PortaMon, a portable NIR device, attached to the subject's dominant side musculature. ΔTSI% between the vastus lateralis and latissimus dorsi were analysed using either paired (2-tailed) t-tests or Wilcoxon signed rank test. The level of significance for analysis was set at p<0.05. No significant difference (p=0.686) was found in ΔTSI (%) between the VL and LD in club level swimmers. A significant difference (p=0.043) was found in ΔTSI (%) between the VL and LD in club level triathletes. Club level swimmers completed the 200 m freestyle swim significantly faster (p=0.04) than club level triathletes. Club level swimmers use both the upper and lower muscles to a similar extent during a maximal 200 m swim. Club level triathletes predominately use the upper body for propulsion during the same exercise. The data produced by NIRS in this study are the first of their kind and provide insight into muscle oxygenation changes during swim exercise which can indicate the

  12. Elective cross-over transfer of the foot: case report.

    PubMed

    Cavadas, Pedro C; Thione, Alessandro; Landín, Luis

    2010-10-01

    The case of a patient with sequels of a right Syme amputation and a left replanted upper tibial amputation was treated with elective cross-transfer of the left foot and ankle to the right distal tibial stump, and the left below-knee (BK) stump was resurfaced with a latissimus dorsi free flap. The patient regained independent walking capacity with a left BK prosthesis at 8 months postoperatively. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Reanimation surgery in patients with acquired bilateral facial palsy.

    PubMed

    Butler, D P; Johal, K S; Harrison, D H; Grobbelaar, A O

    2017-04-01

    Acquired bilateral facial palsy is rare and causes difficulty with speech and eating, but dynamic reanimation of the face can reduce the effect of these problems. Of 712 patients who had these procedures during our study period, two had an acquired bilateral facial paralysis. In both, reanimation was completed in a single operation using a free-functional transfer of the latissimus dorsi muscle that was coapted to the masseteric branch of the trigeminal nerve. Both patients achieved excellent non-spontaneous excursion and an improvement in function. Careful evaluation of the available donor nerves including thorough examination and electromyographic testing should always be completed before operation.

  14. Breast and chest wall reconstruction with the transverse musculocutaneous gracilis flap in Poland syndrome.

    PubMed

    Huemer, George M; Puelzl, Petra; Schoeller, Thomas

    2012-10-01

    Poland syndrome is a complex chest wall deformity with unilateral hypoplasia of the breast and pectoralis muscle, with a missing anterior axillary fold in its most common form. The authors report their combined experience and technique with the transverse myocutaneous gracilis flap to reconstruct the chest wall and breast either alone or simultaneously. Between June of 2004 and July of 2010, 11 patients (two male patients) were operated on and 14 flaps were transplanted. The authors found that the transverse myocutaneous gracilis flap proved to be a very valuable microsurgical alternative for reconstructing the chest wall and female breast in Poland syndrome with autologous tissue. The flap provides the surgeon maximal freedom of flap insetting for optimal symmetry together with a very inconspicuous donor site regardless of unilateral or bilateral harvesting.

  15. Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay.

    PubMed

    Tsoutsos, D; Gravvanis, A; Kakagia, D; Ghali, S; Papalois, A

    2009-01-01

    The rat abdominal island model has proved to be a reliable and reproducible model for the study of surgical delay procedures. It has been customary to simultaneously divide both the artery and the accompanying vein to obtain maximum survival of the rat TRAM flap undergoing delay procedure. This study evaluates the effect of selective arterial interruption compared to standard vascular delay on flap survival in the rat TRAM flap model. Thirty-six Wistar rats were randomly assigned to three groups (n=12), depending on the vascular ligation selected for the initial experimental delay stage. In group A (control group) no vessels were ligated. In group B the right deep inferior epigastric vessels were preserved and the right superior and left inferior and superior deep vessels were ligated. In group C the right inferior epigastric vessels and the left inferior epigastric vein were preserved while superior epigastric vessels and the left inferior epigastric artery were ligated. For the second stage one week later, TRAM flaps were elevated based on the right deep inferior epigastric vessels, re-inset in their original position and digitally photographed. Skin island viability was determined 96 hours later using digital photography and image-analysis software SigmaScan (SPSS, Inc., Chicago, IL). The percentage of flap survival in control group A was 50+/-6%, in group B 60+/-4% and in group C 85+/-4%. The occlusion of the three vascular pairs in group B improved the survival percentage in comparison to the control group A, but this did not achieve statistical significance. In contrast, the percentage of flap survival in control group C was statistically significant compared to groups A and B (p<0.05, ANOVA). Zone IV exhibited no necrosis in any group C animals. This indicates that delay with preservation of the venous outflow of zone IV results in increased blood supply.

  16. Golgi apparatus in chick skeletal muscle: changes in its distribution during end plate development and after denervation.

    PubMed Central

    Jasmin, B J; Cartaud, J; Bornens, M; Changeux, J P

    1989-01-01

    In the course of studies about the cellular and molecular mechanisms of motor end plate formation, the distribution of the Golgi apparatus (GA) has been investigated by immunofluorescence methods in chick skeletal muscle in primary culture and in innervated muscles of 15-day-old chicks. By using a monoclonal antibody directed against the GA, we confirmed the known distribution of the GA in myogenic cells: a juxtanuclear polarized organization in myoblasts and a perinuclear nonpolarized distribution in myotubes. In contrast, the innervated anterior latissimus dorsi muscle of "young adult" chicks displayed a focal distribution of GA that appeared restricted to areas located underneath the motor end plates identified by alpha-bungarotoxin fluorescent labeling of the acetylcholine receptor. Five days after denervation of anterior latissimus dorsi muscle, a striking reorganization and expansion of the GA was observed. The GA now showed a perinuclear distribution in close association with every nucleus of the muscle fibers as observed in myotubes. The focal distribution of the GA in innervated muscle fibers and its remodeling upon denervation are interpreted in terms of a model of local synthesis, processing, and routing of acetylcholine receptor to the end plate and of regulation of these processes by functional motor innervation. Images PMID:2674951

  17. Reconstruction of through-and-through osteocutaneous defects of the mouth and face with subscapular system flaps.

    PubMed Central

    Kalavrezos, Nicholas; Hardee, Peter S. G. F.; Hutchison, Iain L.

    2005-01-01

    BACKGROUND: Major ablative surgery in the head and neck region may create composite defects involving the oral mucosa, bone and the overlying facial skin. The large surface area and the three-dimensional nature of these defects pose a difficult reconstructive challenge requiring adequate bone and large, positionally versatile skin flaps. PATIENTS AND METHODS: From September 1993 to May 2000, 19 patients with through-and-through osteocutaneous defects of the mouth and face were reconstructed with composite subscapular artery system flaps. The evaluated parameters included: (i) site and dimensions of the tissue defect; (ii) specific flap properties; and (iii) review of the recipient and donor site morbidity. RESULTS: 10 variants of scapular osteocutaneous flaps, eight latissimus dorsi with serratus anterior and rib osteo-myocutaneous flaps, and one combination of an osteocutaneous scapular and myocutaneous latissimus dorsi flap were used to reconstruct composite facial defects with mean dimensions of: skin 54.4 cm(2), mucosa 56.2 cm(2) and bone of 8.2 cm. Ischaemic complications occurred in three patients including one total flap failure and one failure of the bony component in previously irradiated patients. The third flap was successfully salvaged. No significant long-term donor site morbidity was noted. CONCLUSION: Composite flaps based on the subscapular artery system are a versatile reconstructive modality for large through-and-through defects of the mouth and face. PMID:15720908

  18. MVC techniques to normalize trunk muscle EMG in healthy women.

    PubMed

    Vera-Garcia, Francisco J; Moreside, Janice M; McGill, Stuart M

    2010-02-01

    Normalization of the surface electromyogram (EMG) addresses some of the inherent inter-subject and inter-muscular variability of this signal to enable comparison between muscles and people. The aim of this study was to evaluate the effectiveness of several maximal voluntary isometric contraction (MVC) strategies, and identify maximum electromyographic reference values used for normalizing trunk muscle activity. Eight healthy women performed 11 MVC techniques, including trials in which thorax motion was resisted, trials in which pelvis motion was resisted, shoulder rotation and adduction, and un-resisted MVC maneuvers (maximal abdominal hollowing and maximal abdominal bracing). EMG signals were bilaterally collected from upper and lower rectus abdominis, lateral and medial aspects of external oblique, internal oblique, latissimus dorsi, and erector spinae at T9 and L5. A 0.5s moving average window was used to calculate the maximum EMG amplitude of each muscle for each MVC technique. A great inter-subject variability between participants was observed as to which MVC strategy elicited the greatest muscular activity, especially for the oblique abdominals and latissimus dorsi. Since no single test was superior for obtaining maximum electrical activity, it appears that several upper and lower trunk MVC techniques should be performed for EMG normalization in healthy women.

  19. EMG activation of trunk and upper limb muscles following experimentally-induced overpronation and oversupination of the feet in quiet standing.

    PubMed

    Ntousis, Theodoros; Mandalidis, Dimitris; Chronopoulos, Efstathios; Athanasopoulos, Spyros

    2013-02-01

    Kinematic studies have shown that experimentally-induced overpronation or oversupination of the subtalar joint may alter the position of the legs, hips and pelvis and consequently the trunk and upper limb. The purpose of the present study was to examine whether such foot deformity affects the activity of muscles that act on the trunk and upper limb. Twenty-eight healthy individuals (11 males and 17 females) 21.4±1.9 years of age without skeletal deformity, leg length discrepancy (LLD), overpronated or oversupinated feet or excessive lateral pelvic inclination volunteered for the study. Bilateral EMG recordings of the latissimus dorsi, pectoralis major and rectus abdominis were undertaken for 30-s with each subject in the relaxed standing position and at 5° and 10° bilateral or unilateral overpronation or oversupination of the foot on the dominant side using wooden wedge-shape blocks. The recorded EMG activity was normalised based on the EMG activity produced by the muscles under investigation during maximum isometric voluntary contraction. The findings of the present study revealed that neither bilateral nor unilateral overpronation/oversupination of the feet induced a significant alteration of the EMG activity of the latissimus dorsi, pectoralis major and rectus abdominis on either the dominant or non-dominant side. These findings suggest that in the absence of other major structural deformity bilateral or unilateral foot overpronation or oversupination does not affect the EMG activity of muscles that act on the trunk and upper limb in quiet standing.

  20. Muscle functional MRI analysis of trunk muscle recruitment during extension exercises in asymptomatic individuals.

    PubMed

    De Ridder, E M D; Van Oosterwijck, J O; Vleeming, A; Vanderstraeten, G G; Danneels, L A

    2015-04-01

    The present study examined the activity levels of the thoracic and lumbar extensor muscles during different extension exercise modalities in healthy individuals. Therefore, 14 subjects performed four different types of extension exercises in prone position: dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, and dynamic-static leg extension. Pre- and post-exercise muscle functional magnetic resonance imaging scans from the latissimus dorsi, the thoracic and lumbar parts of the longissimus, iliocostalis, and multifidus were performed. Differences in water relaxation values (T2-relaxation) before and after exercise were calculated (T2-shift) as a measure of muscle activity and compared between extension modalities. Linear mixed-model analysis revealed higher lumbar extensor activity during trunk extension compared with leg extension (T2-shift of 5.01 ms and 3.55 ms, respectively) and during the dynamic-static exercise performance compared with the dynamic exercise performance (T2-shift of 4.77 ms and 3.55 ms, respectively). No significant differences in the thoracic extensor activity between the exercises could be demonstrated. During all extension exercises, the latissimus dorsi was the least activated compared with the paraspinal muscles. While all extension exercises are equivalent effective to train the thoracic muscles, trunk extension exercises performed in a dynamic-static way are the most appropriate to enhance lumbar muscle strength.

  1. [Corrective surgery of thoracic anomalies in Poland syndrome. General review of 20 patients].

    PubMed

    Glicenstein, J

    2001-12-01

    Breast and thoracic anomalies in Poland's syndrome, whether associated or not with hypoplasia of the upper limb, have no functional impairment. They present an important cosmetic disgrace. Several methods for correction were proposed: muscular transfer with or without implants. Each one has its advantages and drawbacks. We operated 20 adolescents and adults with this deformity: 13 females and 7 males. If the inferior bundle of the pectoralis major was always absent, other muscular anomalies such as aplasia of the latissimus dorsi may complicate the corrective procedure. The choice of the treatment depends upon the importance of the muscular and sometimes associated costal aplasia, in the young girl, the breast development and in both sexes the position of the nipple. The latissimus dorsi transfer may be considered as the most adapted technique for the pestoralis major replacement. The results are often disappointing due to the secondary muscular atrophy. A composite implant with a part for breast reconstruction and another to fill the subclavicular gap gives satisfactory results but it has the hazards of implants.

  2. Body Image Disorders and Surgical Timing in Patients Affected by Poland Syndrome: Data Analysis of 58 Case Studies.

    PubMed

    Baldelli, Ilaria; Santi, Pierluigi; Dova, Laura; Cardoni, Gaia; Ciliberti, Rosagemma; Franchelli, Simonetta; Merlo, Domenico F; Romanini, Maria V

    2016-04-01

    Poland syndrome is a congenital anomaly of pectoralis muscles, breast, chest, and upper arm. Several studies have reported that patients affected by chest wall deformities often experience body image disorders and decreased quality of life. Cosmetic corrective surgery is generally postponed until physical development is achieved, and latissimus dorsi flap surgery is usually suggested. This study aims to propose a new surgical timing for these patients. Patients affected by Poland syndrome (n = 58) and control patients (n = 50) were included in the study, and their body-related psychopathology was evaluated through the Body Uneasiness Test, a valuable multidimensional tool for the clinical assessment of body uneasiness. The Global Severity Index and several subscales were considered. Age and surgical status were taken into account. Significant differences were detected between Poland syndrome patients and controls with respect to all Body Uneasiness Test subscales. Among subjects aged younger than 20 years, the group of patients not operated on was the most affected, whereas the group of peers after surgery showed scores similar to those detected in the control group. Surgical planning for patients with Poland syndrome should start in the period of growth to allow proper body image stabilization. Current surgical options allow for reduction of the use of invasive interventions such as the latissimus dorsi flap, in favor of less invasive surgical techniques such as expanders, implants, and autologous fat grafting. This new surgical timing will help to ameliorate problems with physical and mental development. Therapeutic, III.

  3. Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

    PubMed Central

    Greenspoon, Joshua A.; Millett, Peter J.; Moulton, Samuel G.; Petri, Maximilian

    2016-01-01

    Background: Tendon transfers can be a surgical treatment option in managing younger, active patients with massive irreparable rotator cuff tears. The purpose of this article is to provide an overview of the use of tendon transfers to treat massive irreparable rotator cuff tears and to summarize clinical outcomes. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Latissimus dorsi transfers have been used for many years in the management of posterosuperior rotator cuff tears with good reported clinical outcomes. It can be transferred without or with the teres major (L’Episcopo technique). Many surgical techniques have been described for latissimus dorsi transfer including single incision, double incision, and arthroscopically assisted transfer. Transfer of the pectoralis major tendon is the most common tendon transfer procedure performed for anterosuperior rotator cuff deficiencies. Several surgical techniques have been described, however transfer of the pectoralis major beneath the coracoid process has been found to most closely replicate the force vector that is normally provided by the intact subscapularis. Conclusion: Tendon transfers can be used successfully in the management of younger patients with massive irreparable rotator cuff tears and minimal glenohumeral arthritis. Improvements in clinical outcomes scores and range of motion have been demonstrated. This can delay arthroplasty, which is of particular importance for younger patients with high functional demands. PMID:27708730

  4. [An animal experiment of construction of functional tissue-engineered bone with cell sheet technology].

    PubMed

    Chen, Tao; Wang, Yanhui; Bu, Lingxue; Li, Ningyi

    2011-08-01

    To construct functional tissue-engineered bone with cell sheet technology and method of traditional bone tissue engineering. Canine bone marrow mesenchymal stem cells (BMSCs) were isolated with the method of density gradient centrifugation and cultured. BMSCs were induced to differentiate into osteoblasts and cultured in temperature-responsive culture dishes at 37 degrees C, 5% CO2 and saturated humidity. BMSCs cell sheet was prepared when temperature was changed to 20 degrees C. Demineralized bone matrix (DBM) and platelet-rich plasma (PRP) were prepared, and complex of DBM/PRP/BMSCs cell sheet/BMSCs was construsted and implanted under the left latissimus dorsi muscle. Complex of DBM/PRP/BMSCs was implanted under the right latissimus dorsi muscle. When temperature dropped at 20 degrees C, BMSCs detached automatically from the temperature-responsive culture dishes and formed an intact cell sheet. The osteogenesis of the DBM/PRP/BMSCs cell sheet/BMSCs group was better than that of the DBM/PRP/ BMSCs group. Cell sheet technology combined with traditional bone tissue provides a new way for construction of ideal functional tissue-engineered bone.

  5. Biomechanical and Electromyographic Comparisons of Isometric Trunk Flexor Endurance Test Postures: Prone Plank Versus V-Sit.

    PubMed

    Musalem, Lindsay L; Stankovic, Tatjana; Glisic, Drazen; Cook, Gillian E; Beach, Tyson A

    2015-12-01

    The objective of this study was to investigate why holding times on 2 different tests of isometric trunk flexor endurance capacity (prone plank and v-sit) are weakly correlated. Body position and ground reaction force data from 10 men and 10 women were used to conduct static biomechanical analyses of both test postures, and bilateral activations of the rectus abdominis, internal and external obliques, latissimus dorsi, and lumbar and thoracic erector spinae were measured in a second sample of 15 men and 15 women while holding the test postures. No between-posture differences in net low back flexor moments were found (P = .111), but the lumbar spine was 28° more flexed in the v-sit than in the plank (P < .001). No between-posture differences were detected in the rectus abdominis (P = .397), external obliques (P = .204), internal obliques (P = .226), or lumbar erector spinae (P = .116) activation levels, but those of the thoracic erector spinae (P = .0253) and latissimus dorsi (P < .001) were greater in the plank than in the v-sit. Altogether, the findings suggest that differences between plank and v-sit holding times are most likely related to between-test differences in lumbar spine postures and shoulder demands.

  6. The effects of Anemonia sulcata toxin II on vertebrate skeletal muscle.

    PubMed Central

    Harris, J. B.; Pollard, S.; Tesseraux, I.

    1985-01-01

    Some effects of the sea anemone toxin, ATX-II, on vertebrate skeletal muscle have been described. At a concentration of 1 X 10(-7)-1 X 10(-6)M, ATX-II caused a sodium-dependent depolarization of the muscle fibres of the rat soleus and extensor digitorum longus, of the mouse soleus and extensor digitorum longus and of the chicken posterior latissimus dorsi. The muscle fibres of the frog sartorius were insensitive to the toxin. Action potentials generated by direct stimulation were prolonged by ATX-II, but the degree of prolongation was variable. Chicken posterior latissimus dorsi muscle fibres were most sensitive in this regard, and mouse extensor digitorum longus were least sensitive. Both denervated and immature muscle fibres were more sensitive to ATX-II than mature innervated muscle fibres. The sensitivity to ATX-II declined rapidly as muscle fibres matured. In some muscles, the prolongation of the action potential was enhanced by repetitive stimulation, but not by the passive depolarization or hyperpolarization of the muscle fibres. The actions of ATX-II could be reversed by washing in all but the innervated soleus of the mature rat. PMID:2864969

  7. Reflex control of posterior shoulder muscles from arm afferents in healthy people.

    PubMed

    Elliott, S C; Hanson, J R; Wellington, J; Alexander, C M

    2011-12-01

    In order to position the hand during functional tasks, control of the shoulder is required. Heteronymous reflexes from the upper limb to shoulder muscles are used to assist in this control. To investigate this further, the radial and ulnar nerves were stimulated at elbow level whilst surface electromyographic activity of posterior deltoid, infraspinatus and latissimus dorsi muscles were recorded. In addition, the cutaneous branch of the radial nerve and the skin of the fifth digit were stimulated in order to investigate any cutaneous contribution to reflex activity. Reflexes were evoked in all three of these shoulder muscles from hand and/or forearm afferents. However, the reflexes differed; whereas both excitatory and inhibitory reflexes were evoked in posterior deltoid and infraspinatus, the reflexes in latissimus dorsi were mainly excitatory. Cutaneomuscular reflexes were seldom evoked here, but when they were present they were generally evoked at longer latencies than the reflexes evoked by mixed nerve stimulation. The results suggest a role for reflexes originating from the forearm and/or hand in the control of the shoulder. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Electromyographic analysis of shoulder muscles during press-up variations and progressions.

    PubMed

    Herrington, Lee; Waterman, Rosemary; Smith, Laura

    2015-02-01

    Due to the versatility of the press-up it is a popular upper extremity strengthening and rehabilitation exercise. Press-up programmes are often progressed by increasing weight-bearing load and using unstable bases of support. Despite the popularity of the press-up research examining press-up variations is limited. The aim of the study was to examine the influence of common press-up exercises on serratus anterior, infraspinatus, anterior deltoid, pectoralis major and latissimus dorsi muscles overall EMG activity. Twenty-one healthy individuals participated in this study. Surface electrodes were placed on pectoralis major, anterior deltoid, infraspinatus, serratus anterior and latissimus dorsi muscles. Participants were tested under 7 static press-up conditions that theoretically progressively increase weight-bearing load and proprioceptive challenge while surface electromyographic activity was recorded. There was a high correlation between increased weight-bearing load and increased EMG activity for all muscles in stable base conditions. The introduction of the unstable base conditions resulted in an activation decline in all muscles. Within the two-armed press-up the Swiss ball resulted in decreased activation in all muscles except pectoralis major. Serratus anterior demonstrated the greatest activation as a percentage of maximum isometric contraction across all exercises. The findings of this study indicate that by varying the weight-bearing load and base of support whilst in the press-up position results in significantly different demands on shoulder and scapula muscles. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. An electromyographic evaluation of dual role breathing and upper body muscles in response to front crawl swimming.

    PubMed

    Lomax, M; Tasker, L; Bostanci, O

    2015-10-01

    The upper body trunk musculature is key in supporting breathing, propulsion, and stabilization during front crawl swimming. The aim of this study was to determine if the latissimus dorsi, pectoralis major, and serratus anterior contributed to the development of inspiratory muscle fatigue observed following front crawl swimming. Fourteen trained swimmers completed a 200-m front crawl swim at 90% of race pace. Maximal inspiratory and expiratory mouth pressures (PImax and PEmax) were assessed before (baseline) and after each swim, and electromyography was recorded from the three muscles. Post-swim PImax fell by 11% (P < 0.001, d = 0.57) and the median frequency (MDF: a measure of fatigue) of the latissimus dorsi, pectoralis major, and serratus anterior fell to 90% (P = 0.001, d = 1.57), 87% (P = 0.001, r = -0.60) and 89% (P = 0.018, d = 1.04) of baseline, respectively. The fall in serratus anterior MDF was correlated with breathing frequency (r = 0.675, P = 0.008) and stroke rate (r = 0.639, P = 0.014). The results suggest that the occurrence of inspiratory muscle fatigue was partly caused by fatigue of these muscles, and that breathing frequency and stroke rate particularly affect the serratus anterior. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers.

    PubMed

    Greenspoon, Joshua A; Millett, Peter J; Moulton, Samuel G; Petri, Maximilian

    2016-01-01

    Tendon transfers can be a surgical treatment option in managing younger, active patients with massive irreparable rotator cuff tears. The purpose of this article is to provide an overview of the use of tendon transfers to treat massive irreparable rotator cuff tears and to summarize clinical outcomes. A selective literature search was performed and personal surgical experiences are reported. Latissimus dorsi transfers have been used for many years in the management of posterosuperior rotator cuff tears with good reported clinical outcomes. It can be transferred without or with the teres major (L'Episcopo technique). Many surgical techniques have been described for latissimus dorsi transfer including single incision, double incision, and arthroscopically assisted transfer. Transfer of the pectoralis major tendon is the most common tendon transfer procedure performed for anterosuperior rotator cuff deficiencies. Several surgical techniques have been described, however transfer of the pectoralis major beneath the coracoid process has been found to most closely replicate the force vector that is normally provided by the intact subscapularis. Tendon transfers can be used successfully in the management of younger patients with massive irreparable rotator cuff tears and minimal glenohumeral arthritis. Improvements in clinical outcomes scores and range of motion have been demonstrated. This can delay arthroplasty, which is of particular importance for younger patients with high functional demands.

  11. Muscle activation behavior in a swimming exergame: Differences by experience and gaming velocity.

    PubMed

    Soltani, Pooya; Figueiredo, Pedro; Fernandes, Ricardo J; Vilas-Boas, João Paulo

    2017-11-01

    The effects of playing intensity and prior exergame and sport experience on the activation patterns of upper limb muscles during a swimming exergame were investigated. Surface electromyography of Biceps Brachii, Triceps Brachii, Latissimus Dorsi, Upper Trapezius, and Erector Spinae of twenty participants was recorded, and the game play was divided into normal and fast. Mean muscle activation, normalized to maximum voluntary isometric contraction (MVIC), ranged from 4.9 to 95.2%MVIC and differed between normal and fast swimming for all techniques (p<0.05), except for Latissimus Dorsi during backstroke. After normalizing the %MVIC to playing velocity, selective behaviors were observed between muscles which were sufficient for pragmatic game play. Moreover, prior exergame and real sport experience did not have any effect on the muscle activation changes between normal and fast swimming. These behaviors are likely to happen when players understand the game mechanics, even after a short exposure. Such evaluation might help in adjusting the physical demands of sport exergames, for safe and meaningful experiences. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema.

    PubMed

    García-Yuste, M; Ramos, G; Duque, J L; Heras, F; Castanedo, M; Cerezal, L J; Matilla, J M

    1998-03-01

    The purpose of this study is to report our 15-year experience treating chronic empyemas after pulmonary resection and tuberculosis. Open-window thoracostomy and thoracomyoplasty were used to treat 40 patients with chronic pleural empyema characterized by residual empyematic cavity, bronchopleural fistula, and persistent pleural infections that were secondary to tuberculosis (n = 22) or pulmonary resection (n = 18). Between 2 and 7 months after thoracostomy, thoracomyoplasty was performed to eliminate a persistent pleural cavity. In 2 patients with postpulmonary resection empyema and a large bronchopleural fistula, intrathoracic transposition of the latissimus dorsi flap and open-window thoracostomy were performed simultaneously to close the fistula. The pleural space was eliminated per primam intentionem in 21 of 22 patients with tuberculosis and in 14 of 18 with a postpulmonary resection empyema. Another myoplasty was performed in an additional 3 patients to eliminate the pleural space. During open-window thoracostomy, the latissimus dorsi muscle was preserved with minimal injury to the anterior serratus muscle. One patient died postoperatively. Successful treatment of chronic pleural empyema requires adequate timing of surgical procedures. Our two-procedure technique is relatively simple and safe.

  13. The vitamin C transporter SVCT2 is down-regulated during postnatal development of slow skeletal muscles.

    PubMed

    Sandoval, Daniel; Ojeda, Jorge; Low, Marcela; Nualart, Francisco; Marcellini, Sylvain; Osses, Nelson; Henríquez, Juan Pablo

    2013-06-01

    Vitamin C plays key roles in cell homeostasis, acting as a potent antioxidant as well as a positive modulator of cell differentiation. In skeletal muscle, the vitamin C/sodium co-transporter SVCT2 is preferentially expressed in oxidative slow fibers. Besides, SVCT2 is up-regulated upon the early fusion of primary myoblasts. However, our knowledge of the postnatal expression profile of SVCT2 remains scarce. Here we have analyzed the expression of SVCT2 during postnatal development of the chicken slow anterior and fast posterior latissimus dorsi muscles, ranging from day 7 to adulthood. SVCT2 expression is consistently higher in the slow than in the fast muscle at all stages. After hatching, SVCT2 expression is significantly down-regulated in the anterior latissimus dorsi, which nevertheless maintains a robust slow phenotype. Taking advantage of the C2C12 cell line to recapitulate myogenesis, we confirmed that SVCT2 is expressed in a biphasic fashion, reaching maximal levels upon early myoblasts fusion and decreasing during myotube growth. Together, these findings suggest that the dynamic expression levels of SVCT2 could be relevant for different features of skeletal muscle physiology, such as muscle cell formation, growth and activity.

  14. Free perforating branch flap for primary repairing the huge soft-tissue defects on the scalp and face.

    PubMed

    Wang, Hong-Yuan; Wang, Ming-Gang; Yu, Gang; Chu, Yan-Jun; Wang, Kai; Wei, Xiang-Pin; Sun, Jing-Wu

    2016-11-01

    This study aimed to explore the effect of free perforating branch flap on the reconstruction of huge soft-tissue defects on the scalp and face. Sixteen cases of huge soft-tissue defects on the scalp and face were reconstructed by nine latissimus dorsi-free perforator flaps and seven anterolateral thigh-free perforator flaps. The defects area was from 12 cm× 7 cm to 20 cm × 11 cm, while the flaps area was from 14 cm × 8 cm to 23 cm × 12 cm. The survival, planeness, chromatic aberration, radiotherapy toleration of flap and the function, scar of donor site were observed postoperatively. All of the flaps were survived completely, and 15 cases presented for primary reconstruction; one underwent secondary reconstruction. One of the patients died one-year postoperatively due to intracranial tumor recurrence and the others had no recurrence. All of the flaps showed perfect shape and appropriate thickness. No roentgen ulcer was observed except for some extent of chromatic aberration. The donor-site scar was larvaceous and the function was good. This study indicated that the latissimus dorsi-free perforator flap or anterolateral thigh-free perforator flap was an ideal choice for the reconstruction of defects on the scalp and face.

  15. Free flap scalp reconstruction in a 91-year-old patient under local-regional anesthesia: case report and review of the literature.

    PubMed

    Carey, Joseph Nicholas; Watt, Andrew J; Ho, Oscar; Zeidler, Kamakshi; Lee, Gordon Kwanlyp

    2012-03-01

    In the elderly population with significant medical comorbidities, the safety of general anesthesia is often in question. In the head and neck, where regional and extradural anesthesia are not options, reconstruction of defects requiring free tissue transfer becomes a particular challenge for patients in whom general anesthesia is contraindicated. We present a case of a scalp reconstruction utilizing a latissimus dorsi free flap in a 91-year-old man performed entirely under local and regional anesthesia. General anesthesia was contraindicated secondary to the patient's multiple medical comorbidities. A paravertebral block was used for the harvest of the latissimus dorsi muscle and skin grafts. The microvascular portion of the procedure and the inset were performed under local anesthesia alone. The patient tolerated the procedure, and the operation was successful. This case is unique in that there are no published reports of head and neck free tissue transfer being performed entirely under local-regional anesthesia. We conclude that despite the medical challenges of performing complex reconstruction in elderly patients, expedient free tissue transfer can offer patients access to successful reconstruction.

  16. The effects of Anemonia sulcata toxin II on vertebrate skeletal muscle.

    PubMed

    Harris, J B; Pollard, S; Tesseraux, I

    1985-09-01

    Some effects of the sea anemone toxin, ATX-II, on vertebrate skeletal muscle have been described. At a concentration of 1 X 10(-7)-1 X 10(-6)M, ATX-II caused a sodium-dependent depolarization of the muscle fibres of the rat soleus and extensor digitorum longus, of the mouse soleus and extensor digitorum longus and of the chicken posterior latissimus dorsi. The muscle fibres of the frog sartorius were insensitive to the toxin. Action potentials generated by direct stimulation were prolonged by ATX-II, but the degree of prolongation was variable. Chicken posterior latissimus dorsi muscle fibres were most sensitive in this regard, and mouse extensor digitorum longus were least sensitive. Both denervated and immature muscle fibres were more sensitive to ATX-II than mature innervated muscle fibres. The sensitivity to ATX-II declined rapidly as muscle fibres matured. In some muscles, the prolongation of the action potential was enhanced by repetitive stimulation, but not by the passive depolarization or hyperpolarization of the muscle fibres. The actions of ATX-II could be reversed by washing in all but the innervated soleus of the mature rat.

  17. Abdominal muscle activation changes if the purpose is to control pelvis motion or thorax motion.

    PubMed

    Vera-Garcia, Francisco J; Moreside, Janice M; McGill, Stuart M

    2011-12-01

    The aim of this study was to compare trunk muscular recruitment and lumbar spine kinematics when motion was constrained to either the thorax or the pelvis. Nine healthy women performed four upright standing planar movements (rotations, anterior-posterior translations, medial-lateral translations, and horizontal circles) while constraining pelvis motion and moving the thorax or moving the pelvis while minimizing thorax motion, and four isometric trunk exercises (conventional curl-up, reverse curl-up, cross curl-up, and reverse cross curl-up). Surface EMG (upper and lower rectus abdominis, lateral and medial aspects of external oblique, internal oblique, and latissimus dorsi) and 3D lumbar displacements were recorded. Pelvis movements produced higher EMG amplitudes of the oblique abdominals than thorax motions in most trials, and larger lumbar displacements in the medial-lateral translations and horizontal circles. Conversely, thorax movements produced larger rotational lumbar displacement than pelvis motions during rotations and higher EMG amplitudes for latissimus dorsi during rotations and anterior-posterior translations and for lower rectus abdominis during the crossed curl-ups. Thus, different neuromuscular compartments appear when the objective changes from pelvis to thorax motion. This would suggest that both movement patterns should be considered when planning spine stabilization programs, to optimize exercises for the movement and muscle activations desired. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Cyclic mechanical preconditioning improves engineered muscle contraction.

    PubMed

    Moon, Du Geon; Christ, George; Stitzel, Joel D; Atala, Anthony; Yoo, James J

    2008-04-01

    The inability to engineer clinically relevant functional muscle tissue remains a major hurdle to successful skeletal muscle reconstructive procedures. This article describes an in vitro preconditioning protocol that improves the contractility of engineered skeletal muscle after implantation in vivo. Primary human muscle precursor cells (MPCs) were seeded onto collagen-based acellular tissue scaffolds and subjected to cyclic strain in a computer-controlled bioreactor system. Control constructs (static culture conditions) were run in parallel. Bioreactor preconditioning produced viable muscle tissue constructs with unidirectional orientation within 5 days, and in vitro-engineered constructs were capable of generating contractile responses after 3 weeks of bioreactor preconditioning. MPC-seeded constructs preconditioned in the bioreactor for 1 week were also implanted onto the latissimus dorsi muscle of athymic mice. Analysis of tissue constructs retrieved 1 to 4 weeks postimplantation showed that bioreactor-preconditioned constructs, but not statically cultured control tissues, generated tetanic and twitch contractile responses with a specific force of 1% and 10%, respectively, of that observed on native latissimus dorsi. To our knowledge, this is the largest force generated for tissue-engineered skeletal muscle on an acellular scaffold. This finding has important implications to the application of tissue engineering and regenerative medicine to skeletal muscle replacement and reconstruction.

  19. Reconstruction of the form and function of lateral malleolus and ankle joint.

    PubMed

    Kiyokawa, Kensuke; Tanaka, Shinsuke; Kiduka, Yuichiro; Inoue, Yojiro; Yamauchi, Toshihiko; Tai, Yoshiaki

    2005-08-01

    Soft-tissue reconstruction alone cannot obtain normal ankle function in patients with large defects in the area of the lateral malleolus. The authors report a functional reconstructive method for the lateral malleolus, utilized in a male patient whose osteosarcoma in the fibula was resected with surrounding soft tissue. In order to reconstruct the lateral malleolus, the remaining half of the fibula at the knee was removed, and the fibular head was fixed with the tibia at the ankle joint. Ligaments were reconstructed with tendon grafts. Skin and soft-tissue defects were reconstructed with a combined composite flap comprised of a latissimus dorsi myocutaneous flap and a serratus anterior muscle flap. Dead space around the bone graft was filled with the serratus anterior muscle flap that was divided into two portions. The surface was covered with the latissimus dorsi myocutaneous flap. The patient regained almost normal function of the ankle joint. This technique would be a useful functional reconstructive method for patients with large defects in the area of the lateral malleolus.

  20. Invasive Squamous Cell Carcinoma of the Scalp and Calvarium: A Multidisciplinary Approach

    PubMed Central

    Podda, Silvio; Szymanski, Karen

    2016-01-01

    Objective: The correlation between immunosuppression-associated skin cancer and lymphoma has been well established. This includes squamous cell carcinoma and chronic lymphocytic leukemia. When a lesion requires excision, reconstruction can be challenging based on the depth and size of the tumor. We present a patient with chronic lymphocytic leukemia and invasive squamous cell carcinoma of the scalp that extended through the calvarium to the dura mater. His tumors were badly neglected for a long period of time and presented at an advanced stage. Methods: This type of reconstruction was performed utilizing a multidisciplinary approach. Our patient required calvarial reconstruction with titanium mesh, dural reconstruction, latissimus dorsi free flap, and an overlying skin graft. Results: The patient had appropriate resection of his tumor while maintaining flap viability. Postoperatively, he presented with excellent soft-tissue thickness and aesthetic result. Conclusion: We believe that this type of reconstruction was best, considering our patient had a significant scalp and calvarial defect at presentation. Using a latissimus dorsi free flap bestows a robust blood supply to help decrease infections and improve healing and circulation, especially in light of the need of further radiation therapy. PMID:27909467

  1. Method of Breast Reconstruction Determines Venous Thromboembolism Risk Better Than Current Prediction Models

    PubMed Central

    Patel, Niyant V.; Wagner, Douglas S.

    2015-01-01

    Background: Venous thromboembolism (VTE) risk models including the Davison risk score and the 2005 Caprini risk assessment model have been validated in plastic surgery patients. However, their utility and predictive value in breast reconstruction has not been well described. We sought to determine the utility of current VTE risk models in this population and the VTE rate observed in various methods of breast reconstruction. Methods: A retrospective review of breast reconstructions by a single surgeon was performed. One hundred consecutive transverse rectus abdominis myocutaneous (TRAM) patients, 100 consecutive implant patients, and 100 consecutive latissimus dorsi patients were identified over a 10-year period. Patient demographics and presence of symptomatic VTE were collected. 2005 Caprini risk scores and Davison risk scores were calculated for each patient. Results: The TRAM reconstruction group was found to have a higher VTE rate (6%) than the implant (0%) and latissimus (0%) reconstruction groups (P < 0.01). Mean Davison risk scores and 2005 Caprini scores were similar across all reconstruction groups (P > 0.1). The vast majority of patients were stratified as high risk (87.3%) by the VTE risk models. However, only TRAM reconstruction patients demonstrated significant VTE risk. Conclusions: TRAM reconstruction appears to have a significantly higher risk of VTE than both implant and latissimus reconstruction. Current risk models do not effectively stratify breast reconstruction patients at risk for VTE. The method of breast reconstruction appears to have a significant role in patients’ VTE risk. PMID:26090287

  2. Evaluation of muscle fatigue during 100-m front crawl.

    PubMed

    Stirn, Igor; Jarm, Tomaz; Kapus, Venceslav; Strojnik, Vojko

    2011-01-01

    The aim of this study was to evaluate muscle fatigue in upper body muscles during 100-m all-out front crawl. Surface electromyogram (EMG) was collected from the pectoralis major, latissimus dorsi and triceps brachii muscles of 11 experienced swimmers. Blood lactate concentration level increased to 14.1 ± 2.9 mmol l(-1) 5 min after the swim. The velocity, stroke length and stroke rate calculated based on video analysis decreased by 15.0, 5.8 and 7.4%, respectively, during the swim. EMG amplitude of the triceps and the lower part of the latissimus muscles increased, whilst the mean power frequency (MNF) of all muscles significantly decreased by 20-25%. No significant differences in the relative MNF decrease were observed amongst the muscles; however, the differences in the rate of the MNF decrease between the lower part of the latissimus and the triceps brachii muscles were found (P < 0.05). The time of rest between the muscle activation of the two consecutive arm strokes at the end of swimming was extended (P < 0.05). It was concluded that 100-m all-out crawl induced significant fatigue with no evident differences amongst the analysed muscles.

  3. The influence of experimentally induced pain on shoulder muscle activity.

    PubMed

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul; Krogsgaard, Michael R; Nørregaard, Jesper

    2009-04-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  4. Analysis of activity of motor units in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer.

    PubMed

    Sakuta, Naoki; Sasaki, Sei-Ichi; Ochiai, Naoyuki

    2005-04-01

    We examined respiratory activity of motor units (MUs) in the internal intercostal nerves (IICNs)-transferred biceps brachii muscle (IC-biceps) in cats. MUs of IC-biceps showed respiratory discharges in inspiratory and expiratory phases, and these were enhanced by CO2 inhalation. Narrowing the airway also enhanced inspiratory and expiratory MUs activity. A mechanical load to the thorax immediately enhanced inspiratory MUs activity and weakened expiratory MUs activity. We analyzed the cross-correlation of MUs activity in interchondral muscle and IC-biceps to characterize the respiratory spinal descending inputs to motoneurons. We confirmed the short-term synchronization from interchondral muscles indicating divergence of a single respiratory presynaptic axon to thoracic motoneurons, but could not find synchronization from IC-biceps. The motor axonal conduction velocity (axonal CV) of IC-biceps MUs was lower than that of interchondral muscles. There was no correlation between the respiratory recruitment order of IC-biceps MUs and their axonal CV. These results indicate that IC-biceps shows the respiratory activities and afferent inputs from intercostal muscle spindles in the neighboring segments remain influential on activity of IC-biceps. In addition, the short-term synchronization from IC-biceps could not be found, suggesting that the intercostal nerve transfer alters the respiratory spinal descending inputs to thoracic motoneurons.

  5. Output power and metabolic input power of skeletal muscle contracting linearly to compress a pouch in a mock circulatory system.

    PubMed

    Geddes, L A; Badylak, S F; Tacker, W A; Janas, W

    1992-11-01

    Output power and metabolic input power values were determined for unconditioned canine latissimus dorsi (two), gastrocnemius (seven), and triceps (three) muscles contracting linearly to cause compression of a doubly valved pouch in a hydraulic model of the circulation. The motor nerves to the muscles were stimulated tetanically with 450 msec trains of 0.1 msec pulses having a frequency of 50/sec. The muscles were contracted 10, 20, 30, and 40 times per minute and pouch output in milliliters per minute was measured directly for each muscle at each contraction (train) rate. The output power in milliwatts was determined by two methods: (1) by using the pouch output and the pressure rise imparted to the stroke volume (average power) and (2) by using the pressure-volume loop. Metabolic input power in milliwatts was determined from the oxygen consumption in milliliters per minute of the working muscle. It was found that as the pouch output was increased, the pouch output power and the metabolic input power both increased. The average power output was slightly less than that computed from the pressure-volume loop. The mean output power values, when pumping at L liters per minute, were 0.62 L (average) and 0.75 L mW/gm (pressure-volume loop) for the latissimus dorsi muscles; 0.83 L (average) and 1.16 L mW/gm (pressure-volume loop) for the gastrocnemius muscles; and 0.55 L (average) and 0.66 L mW/gm (pressure-volume loop) for the triceps muscles. The percent efficiency of energy conversion ranged from 9.2% to 17.8% for the latissimus dorsi muscles, from 5.1% to 19.5% for the gastrocnemius muscles, and from 10.5% to 27.3% for the triceps muscles. However, it should not be concluded that one muscle type is better than another on the basis of percent efficiency because efficiency does not take endurance into account. An important observation in this study relates to the large output obtained with the three linearly contracting muscle types. All were capable of pumping in

  6. Core muscle activation during Swiss ball and traditional abdominal exercises.

    PubMed

    Escamilla, Rafael F; Lewis, Clare; Bell, Duncan; Bramblet, Gwen; Daffron, Jason; Lambert, Steve; Pecson, Amanda; Imamura, Rodney; Paulos, Lonnie; Andrews, James R

    2010-05-01

    Controlled laboratory study using a repeated-measures, counterbalanced design. To test the ability of 8 Swiss ball exercises (roll-out, pike, knee-up, skier, hip extension right, hip extension left, decline push-up, and sitting march right) and 2 traditional abdominal exercises (crunch and bent-knee sit-up) on activating core (lumbopelvic hip complex) musculature. Numerous Swiss ball abdominal exercises are employed for core muscle strengthening during training and rehabilitation, but there are minimal data to substantiate the ability of these exercises to recruit core muscles. It is also unknown how core muscle recruitment in many of these Swiss ball exercises compares to core muscle recruitment in traditional abdominal exercises such as the crunch and bent-knee sit-up. A convenience sample of 18 subjects performed 5 repetitions for each exercise. Electromyographic (EMG) data were recorded on the right side for upper and lower rectus abdominis, external and internal oblique, latissimus dorsi, lumbar paraspinals, and rectus femoris, and then normalized using maximum voluntary isometric contractions (MVICs). EMG signals during the roll-out and pike exercises for the upper rectus abdominis (63% and 46% MVIC, respectively), lower rectus abdominis (53% and 55% MVIC, respectively), external oblique (46% and 84% MVIC, respectively), and internal oblique (46% and 56% MVIC, respectively) were significantly greater compared to most other exercises, where EMG signals ranged between 7% to 53% MVIC for the upper rectus abdominis, 7% to 44% MVIC for the lower rectus abdominis, 14% to 73% MVIC for the external oblique, and 16% to 47% MVIC for the internal oblique. The lowest EMG signals were consistently found in the sitting march right exercise. Latissimus dorsi EMG signals were greatest in the pike, knee-up, skier, hip extension right and left, and decline push-up (17%-25% MVIC), and least with the sitting march right, crunch, and bent-knee sit-up exercises (7%-8% MVIC

  7. Expression of myogenes in longissimus dorsi muscle during prenatal development in commercial and local Piau pigs

    PubMed Central

    dos Reis, Evelyze Pinheiro; Paixão, Débora Martins; Brustolini, Otávio José Bernardes; Silva, Fabyano Fonseca e; Silva, Walmir; de Araújo, Flávio Marcos Gomes; Salim, Anna Christina de Matos; Oliveira, Guilherme; Guimarães, Simone Eliza Facioni

    2016-01-01

    Abstract This study used qRT-PCR to examine variation in the expression of 13 myogenes during muscle development in four prenatal periods (21, 40, 70 and 90 days post-insemination) in commercial (the three-way Duroc, Landrace and Large-White cross) and local Piau pig breeds that differ in muscle mass. There was no variation in the expression of the CHD8, EID2B, HIF1AN, IKBKB, RSPO3, SOX7 and SUFU genes at the various prenatal ages or between breeds. The MAP2K1 and RBM24 genes showed similar expression between commercial and Piau pigs but greater expression (p < 0.05) in at least one prenatal period. Pair-wise comparisons of prenatal periods in each breed showed that only the CSRP3, LEF1, MRAS and MYOG genes had higher expression (p < 0.05) in at least one prenatal period in commercial and Piau pigs. Overall, these results identified the LEF1 gene as a primary candidate to account for differences in muscle mass between the pig breeds since activation of this gene may lead to greater myoblast fusion in the commercial breed compared to Piau pigs. Such fusion could explain the different muscularity between breeds in the postnatal periods. PMID:27801482

  8. Proteome Analysis of Bovine Longissimus dorsi Muscle Associated with the Marbling Score

    PubMed Central

    Shen, Y. N.; Kim, S. H.; Yoon, D. H.; Lee, H. G.; Kang, H. S.; Seo, K. S.

    2012-01-01

    The breeding value of marbling score in skeletal muscle is an important factor for evaluating beef quality. In the present study, we investigated proteins associated with the breeding value of the marbling score for bovine sirloin to select potential biomarkers to improve meat quality through comparative proteomic analysis. Proteins isolated from muscle were separated by two-dimensional gel electrophoresis. After analyzing images of the stained gel, seven protein spots for the high marbling score group were identified corresponding to changes in expression that were at least two-fold compared to the low marbling score group. Four spots with increased intensities in the high marbling score group were identified as phosphoglycerate kinase 1, triosephophate isomerase, acidic ribosomal phosphoprotein PO, and capping protein (actin filament) Z-line alpha 2. Spots with decreased intensities in the high marbling score group compared to the low score group were identified as 14-3-3 epsilon, carbonic anhydrase II, and myosin light chain 1. Expression of myosin light chain 1 and carbonic anhydrase 2 was confirmed by Western blotting. Taken together, these data could help improve the economic performance of cattle and provide useful information about the underlying the function of bovine skeletal muscle. PMID:25049666

  9. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    PubMed Central

    Liu, Yuan Fang; Vuong, Christopher; Walker, Paul Charles; Peterson, Nathaniel Ray; Inman, Jared Christian; Filho, Pedro Alcantara Andrade; Lee, Steve Choon-Sung

    2016-01-01

    Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free. PMID:27092284

  10. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique

    PubMed Central

    2010-01-01

    An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications. PMID:20459668

  11. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique.

    PubMed

    Gilman, Kaitlyn; Ipaktchi, Kyros; Moore, Ernest E; Barnett, Carlton; Gurunluoglu, Raffi

    2010-05-07

    An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  12. Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

    PubMed Central

    Lykissas, Marios G; Kostas-Agnantis, Ioannis P; Korompilias, Ananstasios V; Vekris, Marios D; Beris, Alexandros E

    2013-01-01

    Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration. PMID:23878776

  13. Reconstruction of finger and elbow function after complete avulsion of the brachial plexus.

    PubMed

    Doi, K; Sakai, K; Kuwata, N; Ihara, K; Kawai, S

    1991-09-01

    Simultaneous reconstruction of elbow and finger function with free muscle and nerve transfers after complete avulsion of the brachial plexus (nerve roots C5 to T1) and its long-term results are presented. The basic procedure combined free or vascular pedicle latissimus dorsi muscle transfer with reinnervation by the spinal accessory nerve to obtain elbow and finger flexion, intercostal nerve transfer of the radial nerve to activate elbow and wrist extensors, and suture of the supraclavicular nerve or intercostal sensory rami to the median nerve to restore hand sensibility. Six patients had some or all of these procedures. Postoperative follow-up ranged from 2 to 5 years. Elbow function was restored completely, and some finger flexion was achieved in all cases, although a dynamic splint was necessary to straighten the digits. Patients have continued to improve in grasp power and finger control. This procedure appears to be promising for the restoration of basic hand function in severely handicapped patients.

  14. Niche reconstructive techniques for complex abdominal wall reconstruction: a review.

    PubMed

    Sue, Gloria R; Narayan, Deepak

    2014-04-01

    Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.

  15. Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

    PubMed

    Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

    2014-01-01

    Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Treatment of the Open Glenohumeral Joint with the Anterior Deltoid Muscle Flap

    PubMed Central

    Xipoleas, George D.; Woods, Daniel; Batac, Joseph; Addona, Tommaso

    2016-01-01

    Summary: Upper extremity reconstruction is most often encountered in trauma patients. Although the rate of complications from elective orthopedic procedures remains relatively low, these complications are oftentimes in the form of open joints or joint infections that can be devastating. Classically, wounds of the shoulder girdle have been treated with large muscles such as the pectoralis major, pectoralis minor, and latissimus dorsi. Flaps more local to the area including the deltoid muscle flap have been overlooked due to their small size. Despite its size, the anterior deltoid can be used for shoulder girdle reconstruction with minimal functional deficit and allows for reconstruction of the glenohumeral joint without sacrifice of the larger muscles of the upper trunk. This study reports a case of a chronic shoulder girdle wound and successful management with the use of an anterior deltoid muscle flap. PMID:27826470

  17. Long-term results after muscle-rib flap transfer for reconstruction of composite limb defects.

    PubMed

    Georgescu, Alexandru V; Ignatiadis, Ioannis; Ileana, Matei; Irina, Capota; Filip, Ardelean; Olariu, Radu

    2011-03-01

    The authors present the long-term results in a series of 44 cases with post-traumatic bone defects solved with muscle-rib flaps, between March 1997 and December 2007. In these cases, we performed 21 serratus anterior-rib flaps (SA-R), 10 latissimus dorsi-rib flaps (LD-R), and 13 LD-SA-R. The flaps were used in upper limb in 18 cases and in lower limb in 26 cases. With an overall immediate success rate of 95.4% (42 of 44 cases) and a primary bone union rate of 97.7% (43 of 44 cases), and despite the few partisans of this method, we consider that this procedure still remains very usefully for small and medium bone defects accompanied by large soft tissue defects.

  18. Lower extremity soft tissue defect reconstruction with the serratus anterior flap.

    PubMed

    Mastroianni, Melissa; Leto Barone, Angelo A; Shanmugarajah, Kumaran; Leonard, David A; Di Rosa, Luigi; Feingold, Randall S; Israeli, Ron; Cetrulo, Curtis L

    2014-03-01

    Reconstruction of limb-threatening lower extremity defects presents unique challenges. The selected method must provide adequate coverage of exposed bone, joints, and tendons while maximizing function of the limb. The traditional workhorse flaps, the free latissimus dorsi and rectus abdominis flaps, have been associated with donor site morbidity and bulkiness that can impair rehabilitation. We report a case series (n = 18) in which the free serratus anterior muscle flap and split thickness skin graft (STSG) was used for lower limb soft tissue coverage. Injuries were due to diabetes (9/18), trauma (7/18), and chronic venous stasis (2/18). A 94% flap survival rate was observed and all but one patient was ambulatory. No donor site morbidity was reported. Our series demonstrates that serratus anterior is an advantageous, reliable free flap with minimal donor site morbidity.

  19. Robotic harvest of the rectus abdominis muscle: principles and clinical applications.

    PubMed

    Ibrahim, Amir E; Sarhane, Karim A; Pederson, John C; Selber, Jesse C

    2014-02-01

    Harvest of the rectus abdominis muscle requires an abdominal incision as well as violation of the anterior rectus sheath, creating the potential for significant surgical-site morbidity (bulges, hernias, infections, seromas). Laparoscopic or endoscopic techniques, although feasible, have not become popular among plastic surgeons due to multiple technical shortcomings. Robotic surgery on the other hand has an easier learning curve, enhanced precision, tremor elimination, motion scaling, high resolution, three-dimensional optics and an intuitive interface. As a result of these advantages, robotic surgery has permeated into the plastic surgery specialty, assuming a role in the harvest of the latissimus dorsi muscle flap and other reconstructive procedures. In this review, the authors discuss its applicability in the harvest of the rectus abdominis muscle.

  20. Male breast cancer originating in an accessory mammary gland in the axilla: a case report.

    PubMed

    Yamamura, Jun; Masuda, Norikazu; Kodama, Yoshinori; Yasojima, Hiroyuki; Mizutani, Makiko; Kuriyama, Keiko; Mano, Masayuki; Nakamori, Shoji; Sekimoto, Mitsugu

    2012-01-01

    Carcinoma of an accessory mammary gland is an extremely rare tumor. A 61-year-old male patient presented with a hard mass measuring 85 mm × 51 mm in the left axilla. Incisional biopsy histopathologically showed an adenocarcinoma compatible with breast carcinoma originating in an accessory mammary gland. Systemic examinations revealed no evidence of malignant or occult primary lesion in the bilateral mammary glands or in other organs. Neoadjuvant chemotherapy was performed for the locally advanced axillary tumor and reduced the tumor to 55 mm in size, and, then, he could undergo complete resection with a negative surgical margin in combination with reconstructive surgery to fill the resulting skin defect with a local flap of the latissimus dorsi muscle. The patient has presented with no metastatic lesion in four years since the operation. This unusual case shows that neoadjuvant chemotherapy is an effective and tolerated therapy for advanced accessory breast cancer in the axilla.

  1. Type IV hypersensitivity to a textured silicone breast implant.

    PubMed

    Dargan, D; McGoldrick, C; Khan, K

    2012-07-01

    We present a case of hypersensitivity to a breast implant in a 57-year old female with breast cancer and hypersensitivity to adhesive dressings. A mastectomy, axillary node clearance, latissimus dorsi flap and silicone implant-based reconstruction were performed. The mammary wound dehisced within three weeks and the implant required removal. No pus was present, and cultures were negative. Three years later, a further silicone implant was inserted. Within three weeks from insertion, the patient required readmission with serous discharge from the wound, flu-like symptoms, low-grade pyrexia and painful swelling at the operative site. The implant was removed. Capsule biopsies demonstrated a large lymphoid cell reaction, in keeping with a delayed hypersensitivity reaction. Patch testing to samples of the implant was positive. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Muscle activity and co-contraction of musculoskeletal model during steering maneuver.

    PubMed

    Gao, Zhen-hai; Fan, Da; Wang, Deping; Zhao, Hui; Zhao, Kaishu; Chen, Chaoyang

    2014-01-01

    In this study a musculoskeletal model of driver steering maneuver was established. The model was driven by the steering angle and steering torque when performing typical steering test. The simulation was calculated using inverse dynamics. Maximum muscle activity and the muscle activity of each muscle were studied afterwards. The key muscles that generated steering torque were scapular portion of deltoid, infraspinatus, latissimus dorsi, subscapularis, triceps long head and triceps lateral head. Muscle co-contraction was analyzed quantitatively and was significantly different from muscle activity. This paper presents a preliminary research on the mechanical properties of upper limb muscles during steering maneuver. The results can serve as references for vehicle design and performance evaluation using the physiological characteristics of drivers.

  3. Outcome and complications of 540 microvascular free flaps: the Hamburg experience.

    PubMed

    Pohlenz, Philipp; Blessmann, Marco; Blake, Felix; Li, Lei; Schmelzle, Rainer; Heiland, Max

    2007-03-01

    The aim of this study was to retrospectively analyze surgical outcome and complications of 540 free flap procedures performed at the Department of Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf during 1987-2005. A total of 532 patients were reconstructed with 540 flaps: 32% were latissimus dorsi flaps, 23% were radial forearm flaps, 21% were iliac crest flaps, 10% were fibula flaps, 6% were jejunal flaps, and 8% were other flaps. Thrombosis of one of the vessels and hematoma were the most frequent causes of failure in microvascular free tissue transfer. A total free flap failure occurred in 34 (6.2%) and a partial flap failure in 42 (7.7%) patients. The most reliable flap in regard to survival was the radial forearm flap. The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck.

  4. Mechanics and energetics of muscle contraction in normal and dystrophic chickens.

    PubMed

    Polinski, W J; Rall, J A

    1982-01-01

    Energy liberation and isometric force generation were compared at 25 degrees C in isolated normal (n = 15) and dystrophic (n = 18) posterior latissimus dorsi muscles (PLD) from 16- to 33-day-old chickens. Twitch-energy liberation in dystrophic muscle decreased by 27 +/- 6%, and force per cross-sectional area decreased by 26 +/- 11%. Tetanic energy liberation in dystrophic PLD was depressed by 32 +/- 10% compared with a 22 +/- 9% reduction in peak force per cross-sectional area plus a 26 +/- 3% reduction in ability to maintain force. Normalizing results using the force-time integral demonstrates an unaltered force generation per unit energy liberation in dystrophic PLD (7 +/- 11% difference from normal). Kinetic properties of the mechanical responses were not significantly different in normal compared with dystrophic PLD. Dystrophic PLD demonstrated hyperexcitability to nerve transection and electrical stimulation. Although force-generating capacity is reduced in dystrophic PLD, coupling of force production to energy utilization appears unaltered.

  5. The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect.

    PubMed

    Momeni, A; Krischak, S; Bannasch, H

    2006-01-01

    High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury.

  6. The relationship between duration of stimulus per day and the extent of hypertrophy of slow-tonic skeletal muscle in the fowl, Gallus gallus.

    PubMed

    Bates, G P

    1993-12-01

    1. Passive stretch stimulus ranging from 30 min to 8 hr per day were studied on the slow twitch latissimus dorsi muscle (ALD) of the fowl for a 5-week period. 2. A significant increase in the mass of the ALD was observed in all daily durations of stretch stimulus applied. Nearly 50% of the mass increase that occurred with stretch of 8 hr per day was obtained from durations of stretch as short as 30 min per day. 3. Given that stretch is the equal of dynamic loading with respect to increasing muscle mass, it is concluded that stretch stimulation periods as short as 30 min per day may be just as effective as longer durations when hypertrophy is the desired result, such as following fracture, or muscle building in order to enhance athletic performance. 4. In fact it may be that longer durations of daily stimulus may be detrimental to the muscle as the functional capacity may be compromised.

  7. Surface EMG based muscle activity analysis for aerobic cyclist.

    PubMed

    Balasubramanian, Venkatesh; Jayaraman, Srinivasan

    2009-01-01

    In this study, we determined the muscle activity of aerobic cyclist on biceps brachii medial, trapezius medial, latissimus dorsi medial, and erector spinae muscles bilaterally during 30 min of cycling. Thirteen male volunteers were chosen and placed in two groups (with and without low back pain (LBP)). Surface electromyography (sEMG) was recorded bilaterally from selected muscle groups for 30 min of cycling for each subject. Statistical tests were performed to determine the difference in fatigue, using mean power frequency difference. LBP group showed a significantly higher fatigue (p<0.05) in left biceps brachii medial when compared to the control group. High fatigue in the back muscles in the LBP group was not found; however, when linear regression was performed for these individuals, the data showed a possibility of worsening in their condition due to 30 min of cycling.

  8. Salvage of postcranioplasty implant exposure using free tissue transfer.

    PubMed

    Chou, Pang-Yun; Lin, Cheng-Hung; Hsu, Chung-Chen; Yang, Wei-Hsun; Kane, Alex A; Lin, Chih-Hung

    2017-08-01

    Refractory implant exposure is frustrating after cranioplasty. The purpose of this study was for the authors to present their experience with free tissue transfer for salvage of postcranioplasty implant exposure. A retrospective medical chart review was conducted on all free tissue transfers performed for exposed implant coverage after cranioplasty between January 2004 and February 2016. Twelve free flaps were performed in 11 patients who underwent postcranioplasty with implant exposure, and whose attempted implant coverage using locoregional flaps had failed. The free flaps used included anterolateral thigh flap, radial forearm flap, anteromedial thigh and rectus femoris chimeric flap, latissimus dorsi flap, gracilis flap, and Juri flap. The flap survival rate was 100%, and 10 of 11 implants (91%) were salvaged without removal. Free tissue transfer should be considered as the preferred reconstructive option for postcranioplasty exposed implant salvage. High rate of implant salvage (>90%) is possible even with chronic implant exposure (>3 months). © 2017 Wiley Periodicals, Inc.

  9. Vibratory segment function after free flap reconstruction of the pharyngoesophagus.

    PubMed

    Haughey, B H; Fredrickson, J M; Sessions, D G; Fuller, D

    1995-05-01

    Reconstructive options following total laryngopharyngectomy include thin, pliable free tissue segments, approximating the natural thickness of the pharyngeal wall. The authors have investigated outcomes in the following clinical series, emphasizing speech and swallowing. Twelve cancer patients underwent laryngopharyngectomy with or without glossectomy. Eight jejunal, 1 radial forearm, and 3 innervated latissimus dorsi flaps were used for vibratory segment (VS) reconstruction, and all 12 patients underwent tracheoesophageal puncture (TEP). Eleven patients achieved intelligible speech, with a median intelligibility of 93%. The vibrating segments showed fluttering of the free flap tissue when studied by videopharyngography. Vocal quality was lower pitched and softer than "conventional" TEP speech. All patients achieved oral intake as their primary mode of nutrition. Free flaps are a successful option for VS reconstruction in patients undergoing laryngopharyngectomy or glossopharyngolaryngectomy, obviating the need for written or electrolarynx communication.

  10. The effect of a lower extremity kinematic constraint on lifting biomechanics.

    PubMed

    Jin, Sangeun; Mirka, Gary A

    2011-11-01

    Leaning against a stationary barrier during manual materials handling tasks is observed in many industrial environments, but the effects of this kinematic constraint on low back mechanics are unknown. Thirteen participants performed two-handed lifting tasks using both a leaning posture and no leaning posture while trunk kinematics, muscle activity and ground reaction force were monitored. Results revealed that lifting with the leaning posture required significantly less activity in erector spinae (26% vs. 36% MVC) and latissimus dorsi (8% vs. 14% MVC), and less passive tissue moment compared with the no leaning posture. Peak sagittal accelerations were lower when leaning, but the leaning posture also had significantly higher slip potential as measured by required coefficient of friction (0.05 vs. 0.36). The results suggested that the leaning lifting strategy provides reduced low back stress, but does so at the cost of increased slip potential.

  11. Socks for the dilated heart. Does passive cardiomyoplasty have a role in long-term care for heart failure patients?

    PubMed

    Gummert, J F; Rahmel, A; Bossert, T; Mohr, F W

    2004-11-01

    Dynamic cardiomyoplasty has been performed in over 1000 patients worldwide but due to limited success the procedure was never been adopted as an alternative approach for the surgical therapy of heart failure. However, observations in these patients showed that the nonstimulated or fibrotic transformed latissimus dorsi by itself led to an improvement of heart failure symptoms. These findings stimulated animal experiments with so-called passive cardiomyoplasty devices. In several animal models, the progression of heart failure could be stopped, and even reversed remodeling could be demonstrated. Several different devices have been developed and tested in animal models. The Acorn CorCap has already passed a successful clinical feasibility study. However, the final evaluation of two multicenter trials has to be awaited to assess the future role of this device in the treatment of heart failure.

  12. [About cover of ballistic wounds of distal third of leg in civilian ways].

    PubMed

    Chichery, A; Mojallal, A; Soubirac, L; Breton, P

    2007-12-01

    Major causes of ballistic wounds are shooting accidents. Goals of this work are to suggest a position about ballistic wounds of leg's distal third. Reconstruction of ballistic wounds of leg's distal third is difficult, because of lack of laxity and veinous drainage in distal third; and characteristics of ballistic wounds. Ballistic traumas give a temporary cavity, which induce levelled wounds of neurovascular pedicules. We present three cases. One patient benefits from a sural flap, whereas the two others benefit respectively from a free parascapular flap and a free latissimus dorsi flap with free osseous graft. Functional results were considered as good. Treatment of ballistic wounds ask for certain specificities: 1) meticulous evaluation of wounds; 2) evaluation of vascular axis of leg. Debridments are numerous under general anaesthesia before a reconstruction with axial regional flap or free flap, which vessels are anastomosed distant. Reconstruction must be done before the tenth day.

  13. Rupture of an extended mycotic aneurysm of the descending thoracic aorta in a multiple myeloma patient undergoing anti-myeloma therapy.

    PubMed

    Marumoto, Akira; Iwata, Keiji

    2016-03-01

    Infectious complications in patients with multiple myeloma remain the main cause of mortality because of disease-related immunodeficiency. A mycotic aortic aneurysm caused by Burkhoderia cepacia, which has been recognized as nosocomial pathogen in immunocompromised populations, is very rare and only few cases have been reported in the literature. We describe an unusual case of a ruptured mycotic aneurysm of the descending thoracic aorta with a DeBakey IIIb aortic dissection caused by Burkhoderia cepacia in a patient with active multiple myeloma during chemotherapy with anti-myeloma agents. Successful treatment of this mycotic aneurysm included appropriate antibiotic therapy and replacement of the aortic arch and the descending aorta for the extensive debridement of all infected aortas. This was followed by the wrapping of a prosthetic graft with a well-vascularized tissue flap of the greater omentum and of the latissimus dorsi muscle.

  14. Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap.

    PubMed

    Eburdery, H; Grolleau, J L; Berthier, C; Bertheuil, N; Chaput, B

    2016-01-01

    The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the superior epigastric artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Muscle powered circulatory assist device for diastolic counterpulsator.

    PubMed

    Novoa, R; Jacobs, G; Sakakibara, N; Chen, J F; Davies, C; Cosgrove, D M; Golding, L R; Nosé, Y; Loop, F D

    1989-01-01

    A diastolic counterpulsator that uses either skeletal muscle or pneumatic actuation was developed. The unit is positioned between the latissimus dorsi and the chest wall, without interference with collateral blood supply, and is connected in series with the descending aorta. The system was able to generate stroke volumes between 52 and 16 ccs against pressures of 60 and 140 mmHg, respectively. Stroke work at 200 msec stimulation averaged 2.8 X 10(6) ergs. Power output at an afterload of 100 mmHg, and at a rate of 60 bpm, was 0.51 W. Back-up pneumatic actuation provided by an intraaortic balloon pump resulted in a 46% increase in the endocardial viability ratio (EVR).

  16. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components.

  17. Improved mechanism for capturing muscle power for circulatory support.

    PubMed

    Trumble, Dennis R; Melvin, David B; Byrne, Mark T; Magovern, James A

    2005-09-01

    Although it is now understood that trained skeletal muscle can generate enough steady-state power to provide significant circulatory support, there are currently no means by which to tap this endogenous energy source to aid the failing heart. To that end, an implantable muscle energy converter (MEC) has been constructed and its function has been improved to optimize durability, anatomic fit, and mechanical efficiency. Bench tests show that MEC transmission losses average less than 10% of total work input and that about 85% of this muscle power is successfully transferred to the working fluid of the pump. Results from canine implant trials confirm excellent biocompatibility and demonstrate that contractile work of the latissimus dorsi muscle-measured to 290 mJ/stroke in one dog-can be transmitted within the body at levels consistent with cardiac assist requirements. These findings suggest that muscle-powered cardiac assist devices are feasible and that efforts to further develop this technology are warranted.

  18. Autologous reconstruction of a complex form of Poland syndrome using 2 abdominal perforator free flaps.

    PubMed

    Masia, Jaume; Pons, Gemma; Loschi, Pietro; Sanchez Porro-Gil, Lidia; Nardulli, Maria Luisa; Olivares, Leyre

    2015-05-01

    Poland syndrome is the most frequent cause of congenital breast aplasia and hypoplasia. Breast and possible chest wall deformities can be treated with several surgical techniques, including implants, and pedicled or free flaps.We describe the case of a young patient with severe Poland syndrome with amastia, athelia, and deformity of the chest wall, and aplasia of 2 ribs. Marked hypoplasia of the ipsilateral latissimus dorsi muscle ruled out a reliable reconstructive option.Two perforator flaps were performed in a single-stage operation. A hemi-deep inferior epigastric perforator flap was harvested to correct the chest deformity, whereas the contralateral superficial inferior epigastric artery flap allowed breast reconstruction.No complications occurred and a subjectively and objectively pleasing cosmetic result was maintained at 3-year follow-up.

  19. Recurrent squamous cell carcinoma of the scalp treated with serial free flaps: A case report.

    PubMed

    Ikander, Peder; Sørensen, Jens Ahm

    2015-09-01

    Reconstruction of large full thickness scalp defects is always a challenge. Many different techniques can be used, but larger defects often call for a free tissue transfer. The purpose of this report is to present one successful way of treating multiple large scalp defects. A 61-year-old man was seen with recurrent squamous cell carcinoma of the scalp. The lesions were of full thickness, about 10-15 cm in diameter and included the calvarial bone and the dura layer. The reconstruction process included split-thickness skin grafting, local flaps, and three free microvascular flaps; two latissimus dorsi flaps and one anterolateral thigh flap. No total flap loss was seen, but partial flap necrosis called for secondarily reconstruction. The final result was cosmetically acceptable and the patient is of good health. In conclusion, serial free microvascular flaps may be used with good results when dealing with large difficult and recurrent scalp defects.

  20. Microvascular free flaps in skull base reconstruction.

    PubMed

    Herr, Marc W; Lin, Derrick T

    2013-01-01

    The anatomical challenges of skull base surgery are well known. Furthermore, ablative and traumatic defects in this region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open resection has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates. Since the size and type of free tissue to be utilized must be individualized to each defect, the accomplished reconstructive surgeon should be extremely versatile and, by extension, facile with a several types of free flaps. Thus, four of the most commonly used flaps--the rectus abdominis, radial forearm, latissimus dorsi and anterolateral thigh flaps--are discussed.

  1. Biomechanical bases of rehabilitation of children with cerebral palsy

    NASA Astrophysics Data System (ADS)

    Davlet'yarova, K. V.; Korshunov, S. D.; Kapilevich, L. V.

    2015-11-01

    Biomechanical analysis and the study results of children's with cerebral palsy (CP) muscles bioelectrical activity while walking on a flat surface are represented. Increased flexion in the hip and shoulder joints and extension in the elbow joint in children with cerebral palsy were observed, with the movement of the lower limbs had less smooth character in comparison with the control group. Herewith, the oscillation amplitude was significantly increased, and the frequency in the m. gastrocnemius and m. lateralis was decreased. It was shown, that the dynamic stereotype of walking in children with cerebral palsy was characterized by excessive involvement of m. gastrocnemius and m.latissimus dorsi in locomotion. Thus, resulting biomechanical and bioelectrical parameters of walking should be considered in the rehabilitation programs development.

  2. Trunk Muscle Activation and Estimating Spinal Compressive Force in Rope and Harness Vertical Dance.

    PubMed

    Wilson, Margaret; Dai, Boyi; Zhu, Qin; Humphrey, Neil

    2015-12-01

    Rope and harness vertical dance takes place off the floor with the dancer suspended from his or her center of mass in a harness attached to a rope from a point overhead. Vertical dance represents a novel environment for training and performing in which expected stresses on the dancer's body are different from those that take place during dance on the floor. Two male and eleven female dancers with training in vertical dance performed six typical vertical dance movements with electromyography (EMG) electrodes placed bilaterally on rectus abdominus, external oblique, erector spinae, and latissimus dorsi. EMG data were expressed as a percentage of maximum voluntary isometric contraction (MVIC). A simplified musculoskeletal model based on muscle activation for these four muscle groups was used to estimate the compressive force on the spine. The greatest muscle activation for erector spinae and latissimus dorsi and the greatest trunk compressive forces were seen in vertical axis positions where the dancer was moving the trunk into a hyper-extended position. The greatest muscle activation for rectus abdominus and external oblique and the second highest compressive force were seen in a supine position with the arms and legs extended away from the center of mass (COM). The least muscle activation occurred in positions where the limbs were hanging below the torso. These movements also showed relatively low muscle activation compression forces. Post-test survey results revealed that dancers felt comfortable in these positions; however, observation of some positions indicated insufficient muscular control. Computing the relative contribution of muscles, expressed as muscle activation and estimated spinal compression, provided a measure of how much the muscle groups were working to support the spine and the rest of the dancer's body in the different movements tested. Additionally, identifying typical muscle recruitment patterns in each movement will help identify key exercises

  3. [Covering of a thoraco-lumbar defect by omentoplasty].

    PubMed

    Le Fourn, B; Loirat, Y; Sartre, J Y; Lejeune, F; Pannier, M

    1997-02-01

    With a case of thoraco-lumbar defect, the authors discuss about different procedures to cover it. In this place, the better procedure is certainly the latissimus dorsi flap, in all combinations. The indication for omentoplasty at this spinal site should not be performed by first intention but by exclusion of other procedures, as in the case considered by the authors. It was a 37-year-old man, paraplegic from the age of 16, with a deep chronic spinal wound, secondary to sepsis of a posterior segmental fixations. A staphylococcus aureus infection which developed as a surgical complication was initially treated with antibiotics and surgical cleaning procedures without removing instrumentation. However, the infection remained active and the material was finally removed. Spinal immobilisation was strengthened by external fixation. The area was cleared of all suspect material, including bone graft, leaving a wide back-wound open to the spine. Spontaneous healing was first attempted, but the size and the chronicity of the wound led us to use pedicled greater omentum to close the defect. The omentum was pedicled on the right gastroepiploic vessels and transferred to the back wound through the posterior abdominal wall muscles, next to the right kidney. This procedure allows rapid healing. In association with suitable antibiotics, it has prevented any recurrent infection after 18 months of follow-up. It was no feasible to cover the wound with a latissimus dorsi flap, considering the importance of this muscle in the movements of a paraplegic and considering the initial impossibility of removing the external fixation.

  4. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective.

    PubMed

    Ho, Adelyn L; Tyldesley, Scott; Macadam, Sheina A; Lennox, Peter A

    2012-03-01

    To describe the clinical outcomes of patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy and preoperative radiotherapy, followed by skin-sparing mastectomy (SSM) and immediate autologous breast reconstruction (IABR). A retrospective review of 30 LABC patients who underwent SSM and IABR between 1997 to 2007 was performed. Data were drawn from patient records and the University of British Columbia (UBC) Breast Reconstruction and British Columbia Cancer Agency databases. All 30 patients received neoadjuvant chemotherapy, preoperative radiotherapy, SSM, and IABR. Fifteen patients (50%) had stage IIIA disease, 13 (43%) stage IIIB, and 2 (6.7%) stage IIIC. Reconstruction types included the pedicled transverse rectus myocutaneous flap (n = 24), the latissimus dorsi flap (n = 5), and a combination of transverse rectus myocutaneous and latissimus dorsi flap (n = 1). The median follow-up was 3.51 years (range 1-9.4 years). Local complications included mastectomy flap necrosis (n = 3), partial flap necrosis (n = 1), fat necrosis (n = 1), seroma (n = 3), infection (n = 2), and flap fibrosis (n = 1). The incidence of donor site complications was 20%. Overall 5-year actuarial locoregional relapse-free, distant relapse-free, and disease-specific survival rates were 80, 65, and 68%, respectively. Excellent or good physician-rated aesthetic results were achieved in 66% of patients. The UBC protocol avoids irradiation of the autologous breast reconstruction. Outcomes compare with findings from similar studies with respect to local recurrence, distant relapse, overall survival, and surgical complication rates. Neoadjuvant chemotherapy and preoperative radiotherapy in LABC patients desiring autologous breast reconstruction can be considered a safe option.

  5. Laparoscopically harvested omental flap for breast reconstruction in Poland syndrome.

    PubMed

    Romanini, M V; Vidal, C; Godoy, J; Morovic, C G

    2013-11-01

    Poland syndrome (PS) is a congenital anomaly of the thoracic wall characterised by a variable degree of unilateral agenesis of pectoralis major and minor muscles associated with ipsilateral breast, rib and upper-arm anomalies. In female patients, breast reconstruction is particularly challenging because of cranial pectoralis muscle defects and partial or complete breast agenesis. Different techniques have been used to treat the thoracic anomaly, including the positioning of an implant, fat transfer or latissimus dorsi transposition, but in some cases these techniques are not feasible resulting in a poor reconstruction. We present our experience in correction of the chest anomaly of PS in a teenage population by using a pedicled laparoscopically harvested omental flap (LOF) to cover a pectoral or breast prosthesis. Procedures were performed by a surgical team which included experienced plastic surgeons and general paediatric surgeons. Preoperative endocrinological and psychological evaluation helped to determine the best timing for the correction. The technique was adopted in 20 patients aged 14-18 years, affected by the syndrome. In all cases, it was possible to harvest an adequate amount of pedicled omentum laparoscopically. Neither significant complications nor conversions to open surgery occurred. The aesthetic outcome of the LOF technique was, in all cases, a soft, natural-looking breast and a satisfactorily corrected infraclavicular defect. The LOF technique is a valid alternative to reconstruction in selected PS cases. It provides a satisfactory reconstruction of the breast and pectoral region and corrects the infraclavicular defect by filling in the area. It avoids the invasiveness and morbidity of a latissimus dorsi transposition. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Does breathing type influence electromyographic activity of obligatory and accessory respiratory muscles?

    PubMed

    Gutiérrez, M F; Valenzuela, S; Miralles, R; Portus, C; Santander, H; Fuentes, A D; Celhay, I

    2014-11-01

    Craniomandibular electromyographic (EMG) studies frequently include several parameters, e.g. resting, chewing and tooth-clenching. EMG activity during these parameters has been recorded in the elevator muscles, but little is known about the respiratory muscles. The aim of this study was to compare EMG activity in obligatory and accessory respiratory muscles between subjects with different breathing types. Forty male subjects were classified according to their breathing type into two groups of 20 each: costo-diaphragmatic breathing type and upper costal breathing type. Bipolar surface electrodes were placed on the sternocleidomastoid, diaphragm, external intercostal and latissimus dorsi muscles. EMG activity was recorded during the following tasks: (i) normal quiet breathing, (ii) maximal voluntary clenching in intercuspal position, (iii) natural rate chewing until swallowing threshold, (iv) short-time chewing. Diaphragm EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in all tasks (P < 0·05). External intercostal EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in tasks 3 and 4 (P < 0·05). Sternocleidomastoid and latissimus dorsi EMG activity did not show significant differences between breathing types in the tasks studied (P > 0·05). The significantly higher EMG activity observed in subjects with upper costal breathing than in the costo-diaphragmatic breathing type suggests that there could be differences in motor unit recruitment strategies depending on the breathing type. This may be an expression of the adaptive capability of muscle chains in subjects who clinically have a different thoraco-abdominal expansion during inspiration at rest.

  7. An evaluation of resource utilisation of single stage porcine acellular dermal matrix assisted breast reconstruction: A comparative study.

    PubMed

    Kilchenmann, Ashley J R; Lardi, Alessia M; Ho-Asjoe, Mark; Junge, Klaus; Farhadi, Jian

    2014-12-01

    To evaluate resource utilization of single stage porcine acellular dermal matrix (ADM) assisted breast reconstruction compared with tissue expander (TE), latissimus dorsi flap and implant (LD/I) and latissimus dorsi flap and TE (LD/TE) reconstructive techniques. Clinical data was collected for length of stay, operative time, additional hospitalisations and operative procedures, and outpatient appointments for 101 patients undergoing unilateral implant based breast reconstruction. Resources utilised by ADM (Strattice Reconstructive Tissue Matrix™) patients were analysed and compared to the resource usage of traditional techniques. 25 patients undergoing single stage ADM (ADM/I) were compared with 27 having TE, 32 having LD/I and 17 having LD/TE reconstructions. Follow up was 24 months. Compared to TE, ADM/I had similar length of stay and operative time, lower rate and number of additional procedures, fewer, shorter re-admissions (p < 0.05) and fewer appointments (p < 0.05). Compared to LD/TE, ADM/I had shorter length of stay and operative time (p < 0.05), lower rate and number of additional procedures, fewer, shorter re-admissions (p < 0.05) and fewer appointments (p < 0.05). Compared to LD/I, ADM/I had shorter length of stay (p < 0.05) and operative time (p < 0.05), fewer appointments, similar rate and number of additional procedures but required more and longer re-admissions. In our experience, unilateral single stage ADM/I was associated with fewer resources utilised in comparison with two staged TE and LD/TE reconstructions in both complication-free and complicated settings over a 24-month period, despite requiring aesthetic revision in 60.9% of patients. Compared to LD/I, resource utilisation was commensurate in complication-free and complicated settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

    PubMed

    Kocur, Piotr; Pospieszna, Barbara; Choszczewski, Daniel; Michalowski, Lukasz; Wiernicka, Marzena; Lewandowski, Jacek

    2017-01-01

    Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

  9. Computational sensitivity analysis to identify muscles that can mechanically contribute to shoulder deformity following brachial plexus birth palsy.

    PubMed

    Crouch, Dustin L; Plate, Johannes F; Li, Zhongyu; Saul, Katherine R

    2014-02-01

    Two mechanisms, strength imbalance or impaired longitudinal muscle growth, potentially cause osseous and postural shoulder deformity in children with brachial plexus birth palsy. Our objective was to determine which muscles, via either deformity mechanism, were mechanically capable of producing forces that could promote shoulder deformity. In an upper limb computational musculoskeletal model, we simulated strength imbalance by allowing each muscle crossing the shoulder to produce 30% of its maximum force. To simulate impaired longitudinal muscle growth, the functional length of each muscle crossing the shoulder was reduced by 30%. We performed a sensitivity analysis to identify muscles that, through either simulated deformity mechanism, increased the posteriorly directed, compressive glenohumeral joint force consistent with osseous deformity or reduced the shoulder external rotation or abduction range of motion consistent with postural deformity. Most of the increase in the posterior glenohumeral joint force by the strength imbalance mechanism was caused by the subscapularis, latissimus dorsi, and infraspinatus. Posterior glenohumeral joint force increased the most owing to impaired growth of the infraspinatus, subscapularis, and long head of biceps. Through the strength imbalance mechanism, the subscapularis, anterior deltoid, and pectoralis major muscles reduced external shoulder rotation by 28°, 17°, and 10°, respectively. Shoulder motion was reduced by 40° to 56° owing to impaired growth of the anterior deltoid, subscapularis, and long head of triceps. The infraspinatus, subscapularis, latissimus dorsi, long head of biceps, anterior deltoid, pectoralis major, and long head of triceps were identified in this computational study as being the most capable of producing shoulder forces that may contribute to shoulder deformity following brachial plexus birth palsy. The muscles mechanically capable of producing deforming shoulder forces should be the focus of

  10. ELECTROMYOGRAPHIC ANALYSIS OF SHOULDER GIRDLE MUSCLES DURING COMMON INTERNAL ROTATION EXERCISES.

    PubMed

    Alizadehkhaiyat, Omid; Hawkes, David H; Kemp, Graham J; Frostick, Simon P

    2015-10-01

    High level throwing performance requires the development of effective muscle activation within shoulder girdle muscles particularly during forceful internal rotation (IR) motions. Controlled Laboratory Descriptive Study. To investigate activation pattern of 16 shoulder girdle muscles/muscle sub-regions during three common shoulder IR exercises. EMG was recorded in 30 healthy subjects from 16 shoulder girdle muscles/muscle sub-regions (surface electrode: anterior, middle and posterior deltoid, upper, middle and lower trapezius, serratus anterior, teres major, upper and lower latissimus dorsi, upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis and rhomboid major) using a telemetric EMG system. Three IR exercises (standing IR at 0° and 90° of Abduction, and IR at Zero-Position) were studied. EMG amplitudes were normalized to EMGmax (EMG at maximal IR force in a standard position) and compared using one-way repeated-measures analysis of variance (ANOVA). There were significant differences in muscles' activation across IR exercises (p<0.05-p<0.001). Rotator cuff and deltoid muscles were highly activated during IR at 90° of Abduction. Latissimus dorsi exhibited markedly higher activation during IR at Zero-Position. While upper trapezius had the highest activation during IR at Zero-Position, middle and lower trapezius were activated at highest during IR at 90° of Abduction. The highest activation of serratus anterior and rhomboid major occurred in IR at Zero-Position and IR at 90° of Abduction, respectively. Studied exercises have the potential to effectively activate glenohumeral and scapular muscles involved in throwing motions. Results provide further evidence for developing rehabilitation, injury prevention, and training strategies. 4, Controlled laboratory study.

  11. Quantifying radiation dose delivered to individual shoulder muscles during breast radiotherapy.

    PubMed

    Lipps, David B; Sachdev, Sean; Strauss, Jonathan B

    2017-03-01

    Radiotherapy is an effective treatment for managing breast cancer, but patients may experience shoulder morbidity after completing radiotherapy. There is a knowledge gap regarding how the inclusion of the regional lymphatics in radiation treatment regimens influence the radiation dose delivered to the underlying shoulder musculature. Five standardized radiation treatment regimens were developed from the computed tomography (CT) scans of 11 patients: tangent fields only (T), high tangent fields (HT), T+supraclavicular fossa and axillary apex with an anterior oblique beam (SCV), T+SCV+axillary nodes with an anterior oblique beam (SCV+AX), and T+SCV+AX with the nodal regions treated with a directly opposed beam configuration (DO). The muscle volumes for nine shoulder muscles anatomically located with the treatment regimens were segmented from the same CT scans. The effect of the nine muscles and five treatment regimens on the percentage of each muscle receiving at least 48Gy (V48Gy) was analyzed with two-way and one-way repeated measures ANOVAs. A statistically significant interaction existed between the nine shoulder muscles and five treatment regimens (p<0.001) on the V48Gy dose. Subsequent one-way analyses found statistically significant main effects of treatment plan on the V48Gy dose for each muscle (p<0.001). The pectoralis major and minor had the greatest V48 doses across the five treatments regimens. The HT, SCV+AX and DO treatment regimens produced statistically significant increases in the V48 dose of the latissimus dorsi and teres major. The infraspinatus, subscapularis, supraspinatus, teres minor, and trapezius only observed statistically significant V48 doses when treated with a DO plan. These findings highlight the muscles (pectoralis major, pectoralis minor, latissimus dorsi, and teres major) that may exhibit future morbidity after radiation, and indicate that nodal RT delivered with a DO beam arrangement delivers the highest muscle dose. Copyright

  12. The thoracoplastic approach to chest wall reconstruction: preliminary results of a multidisciplinary approach to minimize morbidity.

    PubMed

    Basta, Marten N; Fischer, John P; Lotano, Vincent E; Kovach, Stephen J

    2014-12-01

    Chest wall reconstruction remains challenging because of the variable nature of the defect. Muscle-sparing approaches have been described but are not widely applied today. The authors reviewed an institutional experience with chest wall reconstruction and describe the thoracoplastic approach, which aims to optimize flap selection. A retrospective review was conducted identifying all patients undergoing chest wall reconstruction performed by the senior author. Demographic information and operative characteristics were detailed and factors were analyzed for association with postoperative outcomes. Outcomes were also compared for conventional versus thoracoplastic groups. Forty-five patients underwent chest wall reconstruction at an average age of 54.2 ± 16.3 years. Sarcomas were most common (51 percent), followed by breast (16 percent) and lung (11 percent). The average number of ribs resected was 3.2 ± 1.4, with an average defect size of 212 ± 185 cm2. The most commonly used flaps included the latissimus dorsi and pectoralis major (72 percent). Mesh was incorporated in 58 percent of repairs and operative time was 6.2 ± 2.5 hours. The incidence of surgical complications was 23 percent, most commonly wound infection and nonhealing wound (20 percent). The thoracoplastic approach, used in 14 patients, demonstrated no differences in outcomes with follow-up of 14 months. Operative time was nearly identical, and the thoracoplastic group required significantly less blood products when transfused. Latissimus dorsi and pectoralis major flaps were used more frequently in the thoracoplastic group, although this did not reach significance (78.6 percent versus 69.2 percent). The thoracoplastic approach appears to be safe and effective when compared with conventional methods. Although definitive conclusions cannot be drawn, the authors' early experience is promising. The authors believe applying these principles improves aesthetic and functional outcomes and preserves the

  13. Electromyographical Comparison of a Traditional, Suspension Device, and Towel Pull-Up

    PubMed Central

    Snarr, Ronald L.; Hallmark, Ashleigh V.; Casey, Jason C.; Esco, Michael R.

    2017-01-01

    Abstract Strengthening muscles of the back may have various implications for improving functions of daily living, aiding in the transfer of power in throwing, and assist in injury prevention of the shoulder complex. While several versions of the pull-up exist, there is currently no literature comparing their differences. The purpose of this investigation was to compare the electromyographical activity of the latissimus dorsi, posterior deltoid, middle trapezius, and biceps brachii while performing three variations of the pull-up. Resistance-trained men and women (n =15, age = 24.87 ± 6.52 years) participated in this study by performing traditional pull-ups, suspension device pull-ups, and towel pull-ups in a randomized fashion. Each pull-up was performed for three repetitions with a 1.5 bi-acromial grip-width for each participant. Normalized (%MVC) electromyographical values were recorded for each muscle group during each pull-up variation. No significant differences existed within the latissimus dorsi, biceps brachii or posterior deltoid between any of the exercises. For the middle trapezius, towel pull-ups provided significantly lower muscle activity than the traditional pull-up, while no differences between suspension pull-ups and the other variations occurred. In conclusion, only one muscular difference existed between the exercise variations and all versions examined provided electromyographical values, determined by current literature, to invoke a sufficient stimulus to promote increases in muscle strength and hypertrophy. Although further research is needed, practitioners can be confident when programming any of the movement variations examined when attempting to elicit adaptations of muscular strength and hypertrophy. PMID:28828073

  14. Electromyographical Comparison of a Traditional, Suspension Device, and Towel Pull-Up.

    PubMed

    Snarr, Ronald L; Hallmark, Ashleigh V; Casey, Jason C; Esco, Michael R

    2017-09-01

    Strengthening muscles of the back may have various implications for improving functions of daily living, aiding in the transfer of power in throwing, and assist in injury prevention of the shoulder complex. While several versions of the pull-up exist, there is currently no literature comparing their differences. The purpose of this investigation was to compare the electromyographical activity of the latissimus dorsi, posterior deltoid, middle trapezius, and biceps brachii while performing three variations of the pull-up. Resistance-trained men and women (n =15, age = 24.87 ± 6.52 years) participated in this study by performing traditional pull-ups, suspension device pull-ups, and towel pull-ups in a randomized fashion. Each pull-up was performed for three repetitions with a 1.5 bi-acromial grip-width for each participant. Normalized (%MVC) electromyographical values were recorded for each muscle group during each pull-up variation. No significant differences existed within the latissimus dorsi, biceps brachii or posterior deltoid between any of the exercises. For the middle trapezius, towel pull-ups provided significantly lower muscle activity than the traditional pull-up, while no differences between suspension pull-ups and the other variations occurred. In conclusion, only one muscular difference existed between the exercise variations and all versions examined provided electromyographical values, determined by current literature, to invoke a sufficient stimulus to promote increases in muscle strength and hypertrophy. Although further research is needed, practitioners can be confident when programming any of the movement variations examined when attempting to elicit adaptations of muscular strength and hypertrophy.

  15. Fiber Phenotype and Coenzyme Q10 Content in Turkey Skeletal Muscles

    PubMed Central

    Nierobisz, L.S.; Hentz, N.G.; Felts, J.V.; Mozdziak, P.E.

    2010-01-01

    Phenotypical differences between muscle fibers are associated with a source of cellular energy. Coenzyme Q10 (CoQ10) is a major component of the mitochondrial oxidative phosphorylation process, and it significantly contributes to the production of cellular energy in the form of ATP. The objective of this study was to determine the relationship between whole-tissue CoQ10 content, mitochondrial CoQ10 content, mitochondrial protein, and muscle phenotype in turkeys. Four specialized muscles (anterior latissimus dorsi, ALD; posterior latissimus dorsi, PLD; pectoralis major, PM, and biceps femoris, BF) were evaluated in 9- and 20-week-old turkey toms. The amount of muscle mitochondrial protein was determined using the Bradford assay and CoQ10 content was measured using HPLC-UV. The amount of mitochondrial protein relative to total protein was significantly lower (p < 0.05) at 9 compared to 20 weeks of age. All ALD fibers stained positive for anti-slow (S35) MyHC antibody. The PLD and PM muscle fibers revealed no staining for slow myosin heavy chain (S35 MyHC), whereas half of BF muscle fibers exhibited staining for S35 MyHC at 9 weeks and 70% at 20 weeks of age. The succinate dehydrogenase (SDH) staining data revealed that SDH significantly increases (p < 0.05) in ALD and BF muscles and significantly decreases (p < 0.05) in PLD and PM muscles with age. The study reveals age-related decreases in mitochondrial CoQ10 content in muscles with fast/glycolytic profile, and demonstrates that muscles with a slow/oxidative phenotypic profile contain a higher proportion of CoQ10 than muscles with a fast/glycolytic phenotypic profile. Copyright © 2010 S. Karger AG, Basel PMID:20664252

  16. The effectiveness of stretch-shortening cycling in upper-limb extensor muscles during elite cross-country skiing with the double-poling technique.

    PubMed

    Zoppirolli, Chiara; Holmberg, Hans-Christer; Pellegrini, Barbara; Quaglia, Diego; Bortolan, Lorenzo; Schena, Federico

    2013-12-01

    This investigation was designed to evaluate the effectiveness of stretch-shortening cycling (SSC(EFF)) in upper-limb extensor muscles while cross-country skiing using the double-poling technique (DP). To this end, SSC(EFF) was analyzed in relation to DP velocity and performance. Eleven elite cross-country skiers performed an incremental test to determine maximal DP velocity (V(max)). Thereafter, cycle characteristics, elbow joint kinematics and poling forces were monitored on a treadmill while skiing at two sub-maximal and racing velocity (85% of V(max)). The average EMG activities of the triceps brachii and latissimus dorsi muscles were determined during the flexion and extension sub-phases of the poling cycle (EMG(FLEX), EMG(EXT)), as well as prior to pole plant (EMG(PRE)). SSC(EFF) was defined as the ratio of aEMG(FLEX) to aEMG(EXT). EMG(PRE) and EMG(FLEX) increased with velocity for both muscles (P < 0.01), as did SSC(EFF) (from 0.9 ± 0.3 to 1.3 ± 0.5 for the triceps brachii and from 0.9 ± 0.4 to 1.5 ± 0.5 for the latissimus dorsi) and poling force (from 253 ± 33 to 290 ± 36N; P < 0.05). Furthermore, SSC(EFF) was positively correlated to Vmax, to EMG(PRE) and EMG(FLEX) (P < 0.05). The neuromuscular adaptations made at higher velocities, when more poling force must be applied to the ground, exert a major influence on the DP performance of elite cross-country skiers.

  17. Muscular contribution to low-back loading and stiffness during standard and suspended push-ups.

    PubMed

    Beach, Tyson A C; Howarth, Samuel J; Callaghan, Jack P

    2008-06-01

    Push-up exercises are normally performed to challenge muscles that span upper extremity joints. However, it is also recognized that push-ups provide an effective abdominal muscle challenge, especially when the hands are in contact with a labile support surface. The purpose of this study was to compare trunk muscle activation levels and resultant intervertebral joint (IVJ) loading when standard and suspended push-ups were performed, and to quantify and compare the contribution of trunk muscles to IVJ rotational stiffness in both exercises. Eleven recreationally trained male volunteers performed sets of standard and suspended push-ups. Upper body kinematic, kinetic, and EMG data were collected and input into a 3D biomechanical model of the lumbar torso to quantify lumbar IVJ loading and the contributions of trunk muscles to IVJ rotational stiffness. When performing suspended push-ups, muscles of the abdominal wall and the latissimus dorsi were activated to levels that were significantly greater than those elicited when performing standard push-ups (p<.05). As a direct result of these increased activation levels, model-predicted muscle forces increased and consequently led to significantly greater mean (p=.0008) and peak (p=.0012) lumbar IVJ compressive forces when performing suspended push-ups. Also directly resulting from the increased activation levels of the abdominal muscles and the latissimus dorsi during suspended push-ups was increased muscular contribution to lumbar IVJ rotational stiffness (p<.05). In comparison to the standard version of the exercise, suspended push-ups appear to provide a superior abdominal muscle challenge. However, for individuals unable to tolerate high lumbar IVJ compressive loads, potential benefits gained by incorporating suspended push-ups into their resistance training regimen may be outweighed by the risk of overloading low-back tissues.

  18. Musculotopic organization of the motor neurons supplying forelimb and shoulder girdle muscles in the mouse.

    PubMed

    Bácskai, Tímea; Fu, Yuhong; Sengul, Gulgun; Rusznák, Zoltán; Paxinos, George; Watson, Charles

    2013-01-01

    We identified the motor neurons (MNs) supplying the shoulder girdle and forelimb muscles in the C57BL/6J mouse spinal cord using Fluoro-Gold retrograde tracer injections. In spinal cord transverse sections from C2 to T2, we observed two MN columns (medial and lateral) both with ventral and dorsal subdivisions. The dorsolateral column consisted of the biceps brachii, forearm extensors, forearm flexors, and hand MNs, and the ventrolateral column consisted of the latissimus dorsi, trapezius, teres major, deltoid, and triceps MNs. The supraspinatus muscle MNs were located in the dorsomedial column, and pectoralis major and serratus anterior MNs were located in the ventromedial columns. MNs of the dorsolateral column innervated the biceps brachii in mid-C4 to mid-C7, forearm extensors in caudal C4 to mid-T1, forearm flexors in rostral C5 to mid-T1, and hand muscles in mid-C8 to mid-T2 segments. The MNs innervating the trapezius were located in mid-C2 to mid-C4, triceps brachii in mid-C6 to rostral T1, deltoid in rostral C4 to mid-C6, teres major in rostral C5 to mid-C8, and latissimus dorsi in mid-C5 to caudal C8. In addition, MNs innervating the supraspinatus were located from rostral C4 to caudal C8, pectoralis major in mid-C6 to mid-T2, and serratus anterior in rostral C5 to caudal C7/rostral C8 segments. While the musculotopic pattern of MN groups was very similar to that documented for other species, we found differences in the position and cranio-caudal extent of some MN pools compared with previous reports. The identification of mouse forelimb MNs can serve as an anatomical reference for studying degenerative MN diseases, spinal cord injury, and developmental gene expression.

  19. Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom

    PubMed Central

    Bottle, Alex; Mayer, Erik; Patten, Darren K.; Rao, Christopher; Aylin, Paul; Hadjiminas, Dimitri J.; Athanasiou, Thanos; Darzi, Ara; Gui, Gerald

    2015-01-01

    Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions. Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis. Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013. Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline. PMID:26495220

  20. The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients.

    PubMed

    Hanwright, Philip J; Davila, Armando A; Hirsch, Elliot M; Khan, Seema A; Fine, Neil A; Bilimoria, Karl Y; Kim, John Y S

    2013-10-01

    The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes. Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI ≥ 30) and non-obese (BMI < 30). Overall postoperative morbidity, flap complications, non-flap complications, and reoperation rates were compared among the groups. Of 12,986 patients who underwent breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction (p < 0.05). BMI was correlated with increased surgical complications for tissue expander, pedicled TRAM, and free flap reconstructions (OR = 1.09, OR = 1.05, OR = 1.10, respectively; p < 0.05). Medical complications were higher in obese patients undergoing tissue expander and pedicled TRAM reconstructions (p = 0.001 and p < 0.001), but no significant difference was observed in latissimus and free flap reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%). The NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Comparative genome-wide methylation analysis of longissimus dorsi muscles between Japanese black (Wagyu) and Chinese Red Steppes cattle

    PubMed Central

    Yu, Haibin; Li, Guangpeng; Jiang, Ping; Yang, Yuwei; Yang, Runjun; Yu, Xianzhong

    2017-01-01

    DNA methylation is an important epigenetic mechanism involved in expression of genes in many biological processes including muscle growth and development. Its effects on economically important traits are evinced from reported significant differences in meat quality traits between Japanese black (Wagyu) and Chinese Red Steppes cattle, thus presenting a unique model for analyzing the effects of DNA methylation on these traits. In the present study, we performed whole genome DNA methylation analysis in the two breeds by whole genome bisulfite sequencing (WGBS). Overall, 23150 differentially methylated regions (DMRs) were identified which were located in 8596 genes enriched in 9922 GO terms, of which 1046 GO terms were significantly enriched (p<0.05) including lipid translocation (GO: 0034204) and lipid transport (GO: 0015914). KEGG analysis showed that the DMR related genes were distributed among 276 pathways. Correlation analysis found that 331 DMRs were negatively correlated with the expression levels of differentially expressed genes (DEGs) with 21 DMRs located in promoter regions. Our results identified novel candidate DMRs and DEGs correlated with meat quality traits, which will be valuable for future genomic and epigenomic studies of muscle development and for marker assisted selection of meat quality traits. PMID:28771560

  2. Quality of Meat (Longissimus dorsi) from Male Fallow Deer (Dama dama) Packaged and Stored under Vacuum and Modified Atmosphere Conditions

    PubMed Central

    Piaskowska, N.; Daszkiewicz, T.; Kubiak, D.; Zapotoczny, P.

    2016-01-01

    This study evaluated the effect of vacuum and modified atmosphere (40% CO2+60% N2, MA) packaging on the chemical composition, physicochemical properties and sensory attributes of chill-stored meat from 10 fallow deer (Dama dama) bucks at 17 to 18 months of age. The animals were hunter-harvested in the forests of north-eastern Poland. During carcass dressing (48 to 54 h post mortem), both musculus longissimus muscles were cut out. Each muscle was divided into seven sections which were allocated to three groups: 0, A, and B. Samples 0 were immediately subjected to laboratory analyses. Samples A were vacuum-packaged, and samples B were packaged in MA. Packaged samples were stored for 7, 14, and 21 days at 2°C. The results of the present study showed that the evaluated packaging systems had no significant effect on the quality of fallow deer meat during chilled storage. However, vacuum-packaged meat samples were characterised by greater drip loss. Vacuum and MA packaging contributed to preserving the desired physicochemical properties and sensory attributes of meat during 21 days of storage. Regardless of the packaging method used, undesirable changes in the colour, water-holding capacity and juiciness of meat, accompanied by tenderness improvement, were observed during chilled storage. PMID:27165026

  3. UBXN1 polymorphism and its expression in porcine M. longissimus dorsi are associated with water holding capacity.

    PubMed

    Loan, Huynh Thi Phuong; Muráni, Eduard; Maak, Steffen; Ponsuksili, Siriluck; Wimmers, Klaus

    2014-03-01

    The UBX domain containing protein 1-like gene (UBXN1) promotes the protein degradation that affects meat quality, in particular traits related to water holding capacity. The aim of our study was to identify UBXN1 polymorphisms and to analyse their association with meat quality traits. Moreover, the relationship of UBXN1 polymorphisms and its transcript abundance as well as the link between UBXN1 expression and water holding capacity were addressed. Pigs of the breed German landrace (GL) and the commercial crossbreed of Pietrain × [German large white × GL] (PiF1) were used for this study. In GL, the novel SNP c.355 C > T showed significant association with conductivity and drip loss (P ≤ 0.05). Another SNP at nt 674 of the coding sequence [SNP c.674C>T (p.Thr225Ile)] was associated with drip loss (P ≤ 0.05) and pH1 (P ≤ 0.1). In PiF1, the SNP UBXN1 c.674C>T was associated with conductivity (P ≤ 0.01). Moreover, the haplotype combinations showed effects on conductivity within both commercial populations at P ≤ 0.1. In both populations, high expression of UBXN1 tended to decrease water holding capacity in the early post mortem period. The analysis of triangular relationship of UBXN1 polymorphism, transcript abundance, and water holding capacity evidences the existence of a causal polymorphism in cis-regulatory regions of UBXN1 that influences its expression.

  4. Quality of Meat (Longissimus dorsi) from Male Fallow Deer (Dama dama) Packaged and Stored under Vacuum and Modified Atmosphere Conditions.

    PubMed

    Piaskowska, N; Daszkiewicz, T; Kubiak, D; Zapotoczny, P

    2016-12-01

    This study evaluated the effect of vacuum and modified atmosphere (40% CO2+60% N2, MA) packaging on the chemical composition, physicochemical properties and sensory attributes of chill-stored meat from 10 fallow deer (Dama dama) bucks at 17 to 18 months of age. The animals were hunter-harvested in the forests of north-eastern Poland. During carcass dressing (48 to 54 h post mortem), both musculus longissimus muscles were cut out. Each muscle was divided into seven sections which were allocated to three groups: 0, A, and B. Samples 0 were immediately subjected to laboratory analyses. Samples A were vacuum-packaged, and samples B were packaged in MA. Packaged samples were stored for 7, 14, and 21 days at 2°C. The results of the present study showed that the evaluated packaging systems had no significant effect on the quality of fallow deer meat during chilled storage. However, vacuum-packaged meat samples were characterised by greater drip loss. Vacuum and MA packaging contributed to preserving the desired physicochemical properties and sensory attributes of meat during 21 days of storage. Regardless of the packaging method used, undesirable changes in the colour, water-holding capacity and juiciness of meat, accompanied by tenderness improvement, were observed during chilled storage.

  5. Eating Quality Traits of Hanwoo longissimus dorsi Muscle as a Function of End-Point Cooking Temperature

    PubMed Central

    2016-01-01

    Interaction between carcass quality grade and end-point cooking temperature on eating quality of Hanwoo m. longissimus was investigated. Ten (10) of steers were sampled from a commercial population; carcasses with QG 1++ (n=5) and QG 1 (n=5) were chosen. Samples were cooked by electric oven at 60 or 82℃ and compared with uncooked control samples. The pH was not affected by cooking temperature but decreased the redness after cooking and steaks cooked at 60℃ were more reddish than steaks cooked at 82℃ in both QG groups. Higher cooking temperature greatly (p<0.05) increased the cooking loss, but there was no significant interaction between cooking temperature and QG on the cooking loss. Moisture is negatively correlated with temperature in both QG while the proportionate relationship between crude fat and end-point temperature found in QG 1++. WBSF values were significantly (p<0.05) high for QG 1, while that was significantly (p<0.05) increased when the temperature continues to increase. The increasing quality grade of beef resulted in significant higher (p<0.01) level of TBARS and cooking temperature increased TBARS content. Fatty acid composition was not altered by cooking at both temperatures and also the amount of fat intake was not changed. The current study indicates that eating quality of beef m. longissimus was greatly influenced by end-point temperature being interacted with QG. However, the amount and composition of fat were stable regardless of end-point temperatures. These results will provide a consumer reference to determine cooking conditions and intramuscular fat content. PMID:27433099

  6. Eating Quality Traits of Hanwoo longissimus dorsi Muscle as a Function of End-Point Cooking Temperature.

    PubMed

    Yang, Jieun; Jeong, Dawoon; Na, Chong-Sam; Hwang, Inho

    2016-01-01

    Interaction between carcass quality grade and end-point cooking temperature on eating quality of Hanwoo m. longissimus was investigated. Ten (10) of steers were sampled from a commercial population; carcasses with QG 1(++) (n=5) and QG 1 (n=5) were chosen. Samples were cooked by electric oven at 60 or 82℃ and compared with uncooked control samples. The pH was not affected by cooking temperature but decreased the redness after cooking and steaks cooked at 60℃ were more reddish than steaks cooked at 82℃ in both QG groups. Higher cooking temperature greatly (p<0.05) increased the cooking loss, but there was no significant interaction between cooking temperature and QG on the cooking loss. Moisture is negatively correlated with temperature in both QG while the proportionate relationship between crude fat and end-point temperature found in QG 1(++). WBSF values were significantly (p<0.05) high for QG 1, while that was significantly (p<0.05) increased when the temperature continues to increase. The increasing quality grade of beef resulted in significant higher (p<0.01) level of TBARS and cooking temperature increased TBARS content. Fatty acid composition was not altered by cooking at both temperatures and also the amount of fat intake was not changed. The current study indicates that eating quality of beef m. longissimus was greatly influenced by end-point temperature being interacted with QG. However, the amount and composition of fat were stable regardless of end-point temperatures. These results will provide a consumer reference to determine cooking conditions and intramuscular fat content.

  7. Turnover of carbon, nitrogen, and sulfur in bovine longissimus dorsi and psoas major muscles: Implications for isotopic authentication of meat.

    PubMed

    Bahar, B; Moloney, A P; Monahan, F J; Harrison, S M; Zazzo, A; Scrimgeour, C M; Begley, I S; Schmidt, O

    2009-03-01

    Stable isotope ratio analysis of light elements (including C, N, and S) is a powerful tool for inferring the production and geographic origins of animals. The objectives of this research were to quantify experimentally the isotopic turnover of C, N, and S in bovine skeletal muscle (LM and psoas major) and to assess the implications of the turnover for meat authentication. The diets of groups (n = 10 each) of beef cattle were switched from a control diet containing barley and unlabelled urea to an experimental diet containing maize, (15)N-labeled urea, and seaweed for periods of up to 168 d preslaughter. The feeding of the experimental diet was clearly reflected by the delta(13)C, delta(15)N, and delta(34)S values of the LM and psoas major muscles, but isotopic equilibrium was not reached in either muscle for C, N, or S after 168 d of feeding the experimental diet. The slow turnover in skeletal muscle was reflected by the C and N half-lives of 151 and 157 d for LM and 134 and 145 d for psoas major, respectively, and by an S half-life of 219 d in LM. It is concluded that the turnover of light elements (C, N, and S) in bovine skeletal muscles is a slow process; therefore, skeletal muscles contain isotopic information on dietary inputs integrated over a long period of time (months to years).

  8. Optimizing the Combination of Smoking and Boiling on Quality of Korean Traditional Boiled Loin (M. longissimus dorsi)

    PubMed Central

    Choi, Yun-Sang; Kim, Hyun-Wook; Kim, Young-Boong; Kim, Cheon-Jei

    2015-01-01

    The combined effects of smoking and boiling on the proximate composition, technological quality traits, shear force, and sensory characteristics of the Korean traditional boiled loin were studied. Cooking loss, processing loss, and shear force were lower in the smoked/boiled samples than those in the control (without smoking treatment) (p<0.05). The results showed that the boiled loin samples between the control and treatment did not differ significantly in protein, fat, or ash contents, or pH values (p>0.05). The treated samples had higher score for overall acceptability than the control (p<0.05). Thus, these results show that the Korean traditional boiled loin treated with smoking for 60 min before boiling had improved physicochemical properties and sensory characteristics. PMID:26761822

  9. Optimizing the Combination of Smoking and Boiling on Quality of Korean Traditional Boiled Loin (M. longissimus dorsi).

    PubMed

    Choi, Yun-Sang; Kim, Hyun-Wook; Hwang, Ko-Eun; Song, Dong-Heon; Kim, Yong-Jae; Jung, Tae-Jun; Kim, Young-Boong; Kim, Cheon-Jei

    2015-01-01

    The combined effects of smoking and boiling on the proximate composition, technological quality traits, shear force, and sensory characteristics of the Korean traditional boiled loin were studied. Cooking loss, processing loss, and shear force were lower in the smoked/boiled samples than those in the control (without smoking treatment) (p<0.05). The results showed that the boiled loin samples between the control and treatment did not differ significantly in protein, fat, or ash contents, or pH values (p>0.05). The treated samples had higher score for overall acceptability than the control (p<0.05). Thus, these results show that the Korean traditional boiled loin treated with smoking for 60 min before boiling had improved physicochemical properties and sensory characteristics.

  10. Outcomes of scapula stabilization in obstetrical brachial plexus palsy: a novel dynamic procedure for correction of the winged scapula.

    PubMed

    Terzis, Julia K; Papakonstantinou, Konstantinos C

    2002-02-01

    Among the late consequences of obstetrical brachial plexus palsy is winging of the scapula, a functional and aesthetic deformity. This article introduces a novel surgical procedure for the dynamic correction of this clinical entity that involves the dynamic transfer of the contralateral trapezius muscle and/or rhomboid muscles and anchoring to the affected scapula. In more severe cases of scapula winging, the contralateral latissimus dorsi muscle may also need to be transferred to achieve dynamic scapula stabilization. The outcomes of this novel surgical procedure were analyzed in relation to the effect on abduction, external rotation, growth of the scapula, and distance of the scapula from the posterior midline. The results were analyzed in 26 patients who underwent this procedure and had adequate follow-up. The mean patient age was 6.39 years. Fourteen (54 percent) had a diagnosis of Erb palsy, and 12 (46 percent) had a diagnosis of global paralysis. All 26 patients had an additional secondary procedure performed prior to or simultaneously with the scapula stabilization procedure. In 19 patients, the contralateral trapezius was transferred and anchored to the medial border of the winged scapula alone, but in seven cases the underlying rhomboid major was transferred along with the trapezius muscle to provide sufficient scapula stabilization. In five cases in which the scapula winging was severe, the contralateral latissimus dorsi muscle was transferred at a second stage. After this procedure, all patients demonstrated improved scapula symmetry. The mean increase in abduction was 18 degrees (p < 0.001), the mean increase in external rotation was 19 degrees (p < 0.001), and the mean increase in anterior flexion was 12 degrees (p = 0.015). The improvement of the relative position of the winged scapula on the posterior thorax was analyzed by measuring the distance of the inferior angle of both scapulae from the midline, then calculating the difference between normal

  11. Associations between portion size acceptability of beef cuts and ribeye area of beef carcasses.

    PubMed

    Bass, P D; Scanga, J A; Chapman, P L; Smith, G C; Belk, K E

    2009-09-01

    Carcasses that do not conform to mainstream specifications (i.e., those with nonconforming ribeye area) may not achieve their full potential value. Research was conducted to evaluate the relationship between beef carcass LM area at the 12th and 13th rib interface (LMA) and portion size acceptability of other muscles in the carcass. Sixty beef carcass sides of varying LMA sizes (between 67.74 and 116.13 cm(2)) were fabricated to generate 14 individual muscle cuts (triceps brachii long head, infraspinatus, chuckeye complexus, pectoralis profundus, longissimus thoracis, latissimus dorsi, gluteus medius, longissimus lumborum, tensor fasciae latae, psoas major, semimembranosus, biceps femoris, semitendinosus, and vastus lateralis). Retail portion size (g/1.27-cm-thick steak) as well as face surface area and dimensions were recorded for each steak cut perpendicular at the midpoint of the longitudinal axis of each muscle. Subsequently, a nationwide survey was conducted with foodservice chefs and retail meat merchandisers to evaluate acceptability of portion sizes and dimensions of individual muscle cuts. Simple linear regression and nonparametric regression analyses were used to evaluate results of the carcass muscle evaluation and survey, respectively. Results demonstrated that LMA did not affect (P < 0.05) retail portion size of 7 of the 14 muscles (chuckeye complexus, pectoralis profundus, psoas major, semimembranosus, tensor fasciae latae, triceps brachii, and vastus lateralis). Similarly, LMA did not affect (P < 0.05) surface area of steak cross-sectional face areas from 7 of the 14 muscles (chuckeye complexus, psoas major, semimembranosus, tensor fasciae latae, infraspinatus, vastus lateralis, and latissimus dorsi). Muscles for which carcass LMA (P < 0.05) was related to portion size or surface area of portion steaks, or both, were included in the survey. Results of the survey demonstrated that portion size for many muscles were still acceptable to retail

  12. [Current trends of breast reconstruction after mastectomy for breast cancer patients in China: a survey report].

    PubMed

    Chen, Ying; Chen, Jiajian; Chen, Jiaying; Yang, Benlong; Li, Lin; Huang, Xiaoyan; Shao, Zhimin; Shen, Zhenzhou; Yu, Peirong; Wu, Jiong

    2014-11-01

    To explore the current trends of breast reconstruction (BR) for breast cancer patients in China. A questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail. By July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients

  13. The effects of breast size in unilateral postmastectomy breast reconstruction.

    PubMed

    Duggal, Claire S; Grudziak, Joanne; Metcalfe, Drew B; Carlson, Grant W; Losken, Albert

    2013-05-01

    Postmastectomy breast reconstruction is offered to women with breast cancer regardless of body habitus and breast size. The decision regarding technique for breast reconstruction includes patient preference, risk factors, and physical characteristics. The purpose of this study was to determine whether there is a relationship between preoperative breast size and choice of reconstruction, choice of contralateral breast symmetry procedure, and incidence of complications. A retrospective review of 355 patients who underwent unilateral breast reconstruction at Emory University from 2005 to 2009 was performed. Patients were stratified into 3 groups based on mastectomy specimen weight with small breasts defined as less than 500 g, medium breasts as 500 to 1000 g, and large breasts as more than 1000 g. Patient demographics were queried including age and risk factors. Additional data points included type of reconstruction, contralateral procedure, and complications. There were 144 patients with small breasts (40.5%), 150 with medium breasts (42.1%), and 62 with large breasts (17.4%). Women with small breasts were equally likely to undergo tissue expander (34%), latissimus dorsi flap (32%), or TRAM/DIEP flap (34%) reconstruction. Women with medium breasts were most likely to undergo TRAM/DIEP reconstruction (47%), whereas women with large breasts were most likely to undergo latissimus dorsi reconstruction (37%; P = 0.134). Small-breasted women were more likely to undergo contralateral augmentation (P < 0.0001), which varied based on the type of reconstruction. Women with medium-sized breasts were more likely to undergo mastopexy (P = 0.033), and large-breasted women were more likely to undergo reduction (P < 0.0001). Women with complications had a greater mean mastectomy weight than women without complications (744 g compared with 620 g, P = 0.0062), and there was an increasing incidence of postoperative wound infections with increasing breast size (18% of large breasts, 7

  14. Effects of Dry Needling on Spinal Mobility and Trigger Points in Patients with Fibromyalgia Syndrome.

    PubMed

    Castro-Sanchez, Adelaida Maria; Garcia-Lopez, Hector; Mataran-Penarrocha, Guillermo A; Fernandez-Sanchez, Manuel; Fernandez-Sola, Cayetano; Granero-Molina, Jose; Aguilar-Ferrandiz, Maria Encarnacion

    2017-02-01

    The etiology of fibromyalgia syndrome (FMS) is inconclusive, but central mechanisms are well accepted for this pain condition. Myofascial pain syndrome (MPS) is one of the most common musculoskeletal pain diseases and is characterized by myofascial trigger points (MTrPs). It has been suggest that MTrPs have an important factor in the genesis of FMS. The purpose of the current randomized clinical trial was to compare the effectiveness of dry needling versus cross tape on spinal mobility and MTrPs in spinal muscles in patients with FMS. A single-blind randomized controlled trial was conducted on patients with FMS. Clinical setting. Sixty-four patients with FMS were randomly assigned to an experimental group receiving dry needling therapy or to a control group for cross tape therapy in the MTrPs in the latissimus dorsi, iliocostalis, multifidus, and quadratus lumbourum muscles. Spinal mobility measures and MTrPs algometry were recorded at baseline and after 5 weeks of treatment. The repeated measures analysis of variance (ANOVA) demonstrated that significant differences between groups were achieved for the MTrPs in latissimus dorsi muscle (right axillary portion: F = 9.80, P = 0.003); multifidus muscle (right L2 level: F = 11.80, P = 0.001); quadratus lumborum (right lateral superficial upper: F = 6.67, P = 0.012; and right lateral superficial lower: F = 5.38, P = 0.024). In addition, the ANOVA repeated measures test showed significant differences between groups for the segmental amplitude thoracic spine in the standing erect position (F = 7.33, P = 0.009), and segmental amplitude of lumbar spine (F = 11.60, P = 0.001) in the sitting erect position. The outcomes were not collected from a long-term follow-up period. Dry needling therapy or cross tape were used alone when in reality physical therapists usually treat patients with FMS using a multi-modal approach. A non-treatment control group was not included. This study has demonstrated that dry needling therapy

  15. Heart transplantation following cardiomyoplasty: a biological bridge.

    PubMed

    Chachques, Juan C; Jegaden, Olivier J; Bors, Valeria; Mesana, Thierry; Latremouille, Christian; Grandjean, Pierre A; Fabiani, Jean Noel; Carpentier, Alain

    2008-04-01

    Dynamic cardiomyoplasty (CMP) was proposed as a treatment for refractory heart failure; more than 2000 procedures have been performed worldwide. Heart transplantation was indicated afterwards in some CMP patients with recurrent heart failure symptoms. This study reviews the multicentric French experience with CMP followed by heart transplantation. From 1985 to 2007, 212 patients (mean age 53+/-11 years) with refractory heart failure (LVEF=22+/-9%, mean NYHA 3.2) underwent CMP in France. Heart transplantation was performed in 26 patients (12.3%), mean age: 51+/-11 years, within 2.3+/-3 years after CMP. Transplantation was indicated for persistent heart failure, i.e. no immediate improvement after CMP (19%) and for recurring heart failure (81%). The surgical technique of heart transplantation following cardiomyoplasty presents few particularities. Routine extracorporeal bypass was instituted between the vena cavas and the ascending aorta. As in most of these patients the CMP procedure had been performed without the need of extracorporeal circulation, hearts were free of previous cannulations for cardiopulmonary bypass. The latissimus dorsi muscle flap was divided as far as possible inside the left pleural cavity and its vascular pedicle was obturated. The proximal portion of the muscle as well as the muscular pacing electrodes were kept in place in the pleural cavity. The adhesions between the flap and the heart were not released so as to achieve an en bloc resection of the heart and the muscle flap. During removal of the recipient's heart, care was taken not to injure the left phrenic nerve that was frequently in tight relation with the latissimus dorsi muscle. Heart transplantation was then performed in a routine manner, the donor heart being anastomosed to remnant atria and great vessels. Mean follow-up was 5.5 years (longest 13.5 years). Survival at 10 years was 40% for early heart transplantation (done within 4 months of CMP) and 57% for transplantation

  16. New model for cardiomyocyte sheet transplantation using a virus-cell fusion technique

    PubMed Central

    Takahashi, Yuto; Tomotsune, Daihachiro; Takizawa, Sakiko; Yue, Fengming; Nagai, Mika; Yokoyama, Tadayuki; Hirashima, Kanji; Sasaki, Katsunori

    2015-01-01

    AIM: To facilitate close contacts between transplanted cardiomyocytes and host skeletal muscle using cell fusion mediated by hemagglutinating virus of Japan envelope (HVJ-E) and tissue maceration. METHODS: Cardiomyocytes (1.5 × 106) from fetal rats were first cultured. After proliferation, some cells were used for fusion with adult muscle fibers using HVJ-E. Other cells were used to create cardiomyocyte sheets (area: about 3.5 cm2 including 2.1 × 106 cells), which were then treated with Nile blue, separated, and transplanted between the latissimus dorsi and intercostal muscles of adult rats with four combinations of HVJ-E and/or NaOH maceration: G1: HVJ-E(+), NaOH(+), Cardiomyocytes(+); G2: HVJ-E(-), NaOH(+), Cardiomyocytes(+); G3: HVJ-E(+), NaOH(-), Cardiomyocytes(+); G4: HVJ-E(-), NaOH(-), Cardiomyocytes(-). At 1 and 2 wk after transplantation, the four groups were compared by detection of beating domains, motion images using moving target analysis software, action potentials, gene expression of MLC-2v and Mesp1 by reverse transcription-polymerase chain reaction, hematoxylin-eosin staining, and immunostaining for cardiac troponin and skeletal myosin. RESULTS: In vitro cardiomyocytes were fused with skeletal muscle fibers using HVJ-E. Cardiomyocyte sheets remained in the primary transplanted sites for 2 wk. Although beating domains were detected in G1, G2, and G3 rats, G1 rats prevailed in the number, size, motion image amplitudes, and action potential compared with G2 and G3 rats. Close contacts were only found in G1 rats. At 1 wk after transplantation, the cardiomyocyte sheets showed adhesion at various points to the myoblast layer in the latissimus dorsi muscle. At 2 wk after transplantation, close contacts were seen over a broad area. Part of the skeletal muscle sarcoplasma seemed to project into the myocardiocyte plasma and some nuclei appeared to share both sarcoplasmas. CONCLUSION: The present results show that close contacts were acquired and facilitated

  17. Does preoperative abduction value affect functional outcome of combined muscle transfer and release procedures in obstetrical palsy patients with shoulder involvement?

    PubMed Central

    Aydin, Atakan; Ozkan, Turker; Onel, Defne

    2004-01-01

    Background Obstetric palsy is the injury of the brachial plexus during delivery. Although many infants with plexopathy recover with minor or no residual functional deficits, some children don't regain sufficient limb function because of functional limitations, bony deformities and joint contractures. Shoulder is the most frequently affected joint with internal rotation contracture causing limitation of abduction, external rotation. The treatment comprises muscle release procedures such as posterior subscapularis sliding or anterior subscapularis tendon lengtening and muscle transfers to restore the missing external rotation and abduction function. Methods We evaluated whether the preoperative abduction degree affects functional outcome. Between 1998 and 2002, 46 children were operated on to restore shoulder abduction and external rotation. The average age at surgery was 7.6 years and average follow up was 40.8 months. We compared the postoperative results of the patients who had preoperative abduction less than 90° (Group I: n = 37) with the patients who had preoperative abduction greater than 90° (Group II: n = 9), in terms of abduction and external rotation function with angle measurements and Mallet classification. We inquired whether patients in Group I needed another muscle transfer along with latissimus dorsi and teres major transfers. Results In Group I the average abduction improved from 62.5° to 131.4° (a 68.9° ± 22.9°gain) and the average external rotation improved from 21.4° to 82.6° (a 61.1° ± 23°gain). In Group II the average abduction improved from 99.4°to 140°(a40.5° ± 16°gain) and the average external rotation improved from 33.2°to 82.7° (a 49.5° ± 23.9° gain). Although there was a significant difference between Group I and II for preoperative abduction (p = 0.000) and abduction gain in degrees (p = 0.001), the difference between postoperative values of both groups was not significant (p = 0.268). There was also no significant

  18. Volumetric evaluation of fat resorption after breast lipofilling.

    PubMed

    Ho Quoc, C; Taupin, T; Guérin, N; Delay, E

    2015-12-01

    The fat transfer or the lipofilling is a technique that had a major impact on the breast surgery results. We have been using this technique since 1998 as an adjuvant in breast reconstruction. The transferred fat is partially resorbed in the first three months after fat grafting. Literature shows that fat resorption varies from 30 to 80% and the experimental studies register a variation between 50 and 90%. The difficulty of the lipomodeling consists in anticipating the fat resorption rate in order to obtain breast symmetry. The purpose of this article is to evaluate the resorption rate of the transferred fat in the reconstructed breast by means of volumetric imaging 3 months after fat grafting. A prospective study was undertaken including breast reconstructions with total autologous latissimus dorsi. All the surgical procedures have been done by the same surgeon (1st author). It focused on the second stage of breast reconstruction: the lipofilling. We registered the average harvested volumes, the volumes obtained after centrifugation and the transferred volumes for every reconstructed breast. The intramuscular volume in the reconstructed breast was measured by volumetric imaging on the third day after lipofilling (D3) and three months after lipofilling (M3). The volumetry was performed by using an after treatment console SIEMENS (SOMATOM definition AS 2*64 barettes). The average intramuscular volume was registered at D3 and M3. The average volume difference was calculated in order to obtain the exact resorption rate. This prospective study was undertaken on 32 reconstructed breasts by total autologous latissimus dorsi flap. The average age was 52 years, the average BMI was 24.7 kg/m(2). The average harvested fat volume for the breast lipofilling was 560 cc and the volume obtained after centrifugation was evaluated at about 371 cc, the average fat volume transferred being 291 cc. The volumetric study showed that intramuscular volume at D3 was measured at 284 cc and

  19. A Biomechanical Assessment of Ergometer Task Specificity in Elite Flatwater Kayakers

    PubMed Central

    Fleming, Neil; Donne, Bernard; Fletcher, David; Mahony, Nick

    2012-01-01

    The current study compared EMG, stroke force and 2D kinematics during on-ergometer and on-water kayaking. Male elite flatwater kayakers (n = 10) performed matched exercise protocols consisting of 3 min bouts at heart and stroke rates equivalent to 85% of VO2peak (assessed by prior graded incremental test). EMG data were recorded from Anterior Deltoid (AD), Triceps Brachii (TB), Latissimus Dorsi (LD) and Vastus Lateralis (VL) via wireless telemetry. Video data recorded at 50 Hz with audio triggers pre- and post-exercise facilitated synchronisation of EMG and kinematic variables. Force data were recorded via strain gauge arrays on paddle and ergometer shafts. EMG data were root mean squared (20ms window), temporally and amplitude normalised, and averaged over 10 consecutive cycles. In addition, overall muscle activity was quantified via iEMG and discrete stroke force and kinematic variables computed. Significantly greater TB and LD mean iEMG activity were recorded on-water (239 ± 15 vs. 179 ± 10 μV. s, p < 0.01 and 158 ± 12 vs. 137 ± 14 μV.s, p < 0.05, respectively), while significantly greater AD activity was recorded on-ergometer (494 ± 66 vs. 340 ± 35 μV.s, p < 0.01). Time to vertical shaft position occurred significantly earlier on-ergometer (p < 0.05). Analysis of stroke force data and EMG revealed that increased AD activity was concurrent with increased external forces applied to the paddle shaft at discrete phases of the on-ergometer stroke cycle. These external forces were associated with the ergometer loading mechanism and were not observed on- water. The current results contradict a previous published hypothesis on shoulder muscle recruitment during on-water kayaking. Key pointsWhen exercising at fixed heart and stroke rates, biomechanical differences exist between onergometer and on-water kayaking.Ergometer kayaking results in significantly greater Anterior Deltoid activity but significantly lower Triceps Brachii and Latissimus Dorsi activity

  20. Electromyographic Analysis of the Shoulder Girdle Musculature During External Rotation Exercises

    PubMed Central

    Alizadehkhaiyat, Omid; Hawkes, David H.; Kemp, Graham J.; Frostick, Simon P.

    2015-01-01

    Background: Implementation of overhead activity, a key component of many professional sports, requires an effective and balanced activation of the shoulder girdle muscles, particularly during forceful external rotation (ER) motions. Purpose: To identify activation strategies of 16 shoulder girdle muscles/muscle segments during common shoulder ER exercises. Study Design: Descriptive laboratory study. Method: Thirty healthy subjects were included in this study, and 16 shoulder girdle muscles/muscle segments were investigated (surface electrode: anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; serratus anterior; teres major; upper and lower latissimus dorsi; and upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis, and rhomboid major) using a telemetric electromyography (EMG) system. Five ER exercises (standing ER at 0° and 90° of abduction, with underarm towel roll, prone ER at 90° of abduction, side-lying ER with underarm towel) were studied. Exercise EMG amplitudes were normalized to EMG at maximum ER force in a standard position. Univariate analysis of variance and post hoc analysis applied on EMG activity of each muscle were used to assess the main effect of the exercise condition. Results: Muscular activity differed significantly among the ER exercises (P < .05 to P < .001). The greatest activation for anterior and middle deltoid, supraspinatus, upper trapezius, and serratus anterior occurred during standing ER at 90° of abduction; for posterior deltoid, middle trapezius, and rhomboid during side-lying ER with underarm towel; for lower trapezius, upper and lower latissimus dorsi, subscapularis, and teres major during prone ER at 90° of abduction; and for the clavicular and sternal part of the pectoralis major during standing ER with underarm towel. Conclusion: Key glenohumeral and scapular muscles can be optimally activated during specific ER exercises, particularly in positions that

  1. Effects of muscle fiber type on glycolytic potential and meat quality traits in different Tibetan pig muscles and their association with glycolysis-related gene expression.

    PubMed

    Shen, L Y; Luo, J; Lei, H G; Jiang, Y Z; Bai, L; Li, M Z; Tang, G Q; Li, X W; Zhang, S H; Zhu, L

    2015-11-13

    The myosin heavy chain (MyHC) composition, glycolytic potential, mitochondrial content, and gene expression related to energy metabolism were analyzed in eight muscles from Tibetan pigs, to study how meat quality develops in different muscle tissues. The muscles were classified into three clusters, based on MyHC composition: masseter, trapezius, and latissimus dorsi as 'slow-oxidative-type'; psoas major and semimembranosus as 'intermediate-type'; and longissimus dorsi, obliquus externus abdominis, and semitendinosus as 'fast-glycolytic-type'. The 'slow-oxidative-type' muscles had the highest MyHC I and MyHC IIA content (P < 0.01); 'intermediate-type' muscles, the highest MyHC IIx content (P < 0.01); and 'fast-glycolytic-type' muscles, the highest MyHC IIb content (P < 0.01). The pH values measured in 'slow-oxidative-type' muscles were higher than those in the other clusters were; however, the color of 'fast-glycolytic-type' muscles was palest (P < 0.01). Mitochondrial content increased in the order: fast-glycolytic-type < intermediate-type < slow-oxidative-type. In the 'slow-oxidative-type' muscles, the expression levels of genes related to ATP synthesis were higher, but were lower for those related to glycogen synthesis and glycolysis. Mitochondrial content was significantly positively correlated with MyHC I content, but negatively correlated with MyHC IIb content. MyHC I and mitochondrial content were both negatively correlated with glycolytic potential. Overall, muscles used frequently in exercise had a higher proportion of type I fibers. 'Slow-oxidative-type' muscles, rich in type I fibers with higher mitochondrial and lower glycogen and glucose contents, had a higher ATP synthesis efficiency and lower glycolytic capacity, which contributed to their superior meat quality.

  2. Evaluation of Meat Color and Physiochemical Characteristics in Forequarter Muscles of Holstein Steers

    PubMed Central

    Moon, Sung Sil

    2015-01-01

    The beef forequarter muscle comprises approximately 52% of carcass weight. The objective of this study was to evaluate the physiochemical characteristics and meat color from forequarter muscle of Holstein steers. Fifteen forequarter muscles were trimmed of external connective tissue and fat. An experimental group of eight Holstein steers was assessed using meat color, water-holding capacity, drip loss, and Warner–Bratzler shear force value at the same quality grade. The M. omotransversarius (0.45 kg) had the highest (p<0.05) lightness (L*) value, whereas the M. teres major (0.4 kg) and M. triceps brachii (caput laterale) (0.52 kg) had the lowest (p<0.05) values. The M. semispanitus capitus (1.48 kg), which is a neck muscle, had the highest values for both redness (a*) and yellowness (b*), whereas the lowest (p<0.05) values were for the M. teres major. The M. omotransversarius, M. latissimus dorsi (1.68 kg), and M. rhomboideus (1.2 kg) were ranked high (p<0.05) in water-holding capacity. The drip loss value was the highest for the M. longissimus dorsi thoracis (p<0.05; 1.86 kg), while the M. infraspinatus (2.28 kg), M. supraspinatus (1.38 kg), M. brachiocephalicus (1.01 kg), and M. pectoralis superficialis (1.18 kg) had the lowest (p<0.05). The Warner–Bratzler shear force value indicated that the M. pectoralis profundus (3.39 kg), M. omotransversarius, and M. brachiocephalicus were the toughest (p<0.05), whereas the M. subscapularis (0.86 kg), M. longissimus dorsi thoracis, M. teres major, and M. infraspinatus were the most tender cuts (p<0.05). Here, muscle type explained most of the variability in the forequarter physiochemical characteristics. Thus, our findings suggest that these muscle profile data will allow for more informed decisions when selecting individual muscles to produce value-added products from Holstein steers. PMID:26761893

  3. Successful outcome of modified quad surgical procedure in preteen and teen patients with brachial plexus birth palsy.

    PubMed

    Nath, Rahul K; Somasundaram, Chandra

    2012-01-01

    To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5-9 years) with obstetric brachial plexus injury. We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1-17.9 years). The mean preoperative total Mallet score was 14.8 (range, 10-20), and active abduction was 84° (range, 20°-140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13-25, P < .0001), and the mean active abduction improved to 132° (range, 40°-180°, P < .0003). The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder.

  4. Transformation of a vascularised iliac crest or scapula bone to a pedicled osteomuscular transplant for reconstruction of distant defects in the head and neck region: a new method of transforming two island flaps to one longer island flap.

    PubMed

    Kärcher, Hans; Feichtinger, Matthias

    2014-12-01

    Bone defects in the maxillofacial region after ablative surgery require reconstructive surgery, usually using microvascular free flaps. This paper presents a new method of reconstructing extensive defects in patients not suitable for microvascular surgery using prefabrication of a vascularised osteomuscular flap from the scapula or iliac crest bone. Three patients who were treated with this new technique are presented. Two patients (one mandibular defect and one defect in the maxillary region) received prefabricated osteomuscular flaps from the iliac crest bone using the latissimus dorsi muscle as a pedicle. One patient also presenting a mandibular defect after tumour surgery received a scapula transplant for reconstruction of the defect using the pectoralis major muscle as pedicle. In all three cases vital bone could be transplanted. The pedicle was strainless in all three cases. Minor bone loss could be seen initially only in one case. The results are stable now and one patient received dental implants for later prosthetic treatment. The presented two-step surgery provides an excellent method for reconstruction of bony defects in the maxillofacial region in patients where microvascular surgery is not possible due to reduced state of health or lack of recipient vessels. Copyright © 2010. Published by Elsevier Ltd.

  5. Analysis of Microvascular Free Flap Failure Focusing on the Microscopic Findings of the Anastomosed Vessels.

    PubMed

    Seo, Mi Hyun; Kim, Soung Min; Huan, Fan; Myoung, Hoon; Lee, Jong Ho; Lee, Suk Keun

    2015-10-01

    Microvascular flap reconstruction is known as successful technique, although vascular thrombosis can cause free flap failure. To analyze the histologic characteristics and causes of free flap failure, this clinical study examined failed free flaps, including the microanastomosed sites. This study included a total of 5 failed flaps, including 3 radial forearm free flaps, 1 latissimus dorsi free flap, and 1 fibular free flap, all performed with microvascular reconstruction surgery from 2009 to 2011 at Seoul National University Dental Hospital. At the resection surgeries of the failed nonviable flaps, histologic specimens including the microanastomosed vessels were acquired. For light microscope observation, the slides were stained with hematoxylin and eosin (HE), and also with Masson trichrome. Selected portions of graft tissue were also observed under transmission electron microscope (TEM). It was found that the cause of flap failure was the occlusion of vessels because of thrombi formation. During the microanastomosis, damage to the vessel endothelium occurred, followed by intimal hyperplasia and medial necrosis at the anastomosed site. In the TEM findings, some smooth muscle cells beneath endothelium were atrophied and degenerated. The formation of thrombi and the degeneration of the smooth muscle cells were coincident with vascular dysfunction of graft vessel. The damaged endothelium and the exposed connective tissue elements might initiate the extrinsic pathway of thrombosis at the microanastomotic site. Therefore, it is suggested that accurate surgical planning, adequate postoperative monitoring, and skillful technique for minimizing vascular injury are required for successful microvascular transfer.

  6. [Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience].

    PubMed

    Bellidenty, L; Chastel, R; Pluvy, I; Pauchot, J; Tropet, Y

    2014-02-01

    Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.

  7. ACUTE EFFECTS OF DIFFERENT SELF‐MASSAGE VOLUMES ON THE FMS™ OVERHEAD DEEP SQUAT PERFORMANCE

    PubMed Central

    Škarabot, Jakob; Vigotsky, Andrew D; Brown, Amanda Fernandes; Gomes, Thiago Matassoli; Novaes, Jefferson da Silva

    2017-01-01

    Background The Functional Movement Screen (FMS™) is a battery of tests designed to assess movement competency; the overhead deep squat test, specifically, has been shown to be an accurate predictor of overall FMS™ scores. Self‐massage (SM) is a ubiquitous warm‐up utilized to increase joint range of motion and, therefore, may be effective for improving performance of the overhead deep squat test. Purpose To examine how different doses (30, 60, 90, and 120 seconds) of SM of different areas of the body (plantar fascia, latissimus dorsi, and lateral thigh) affects the score obtained on an overhead deep squat test. Methods Twenty recreationally active females were recruited to be tested on four occasions: sessions one and two consisted of baseline testing, session three consisted of SM applied to the lateral thigh, and session four consisted of SM applied to the lateral torso and plantar fascia. Results In all SM conditions, at least 90 seconds was required for a change in deep squat score from baseline; therefore, it is concluded that SM the lateral torso, plantar fascia, and lateral thigh for 90 seconds or more are effective interventions for acutely improving overhead deep squat scores. Conclusion Self‐massage appears to be an effective modality for inducing acute improvements in the performance of the FMS™ overhead deep squat in all conditions tested. Level of evidence 2b PMID:28217420

  8. Autoclaved bone autograph reconstituted with autologous bone marrow.

    PubMed

    Granados-García, Martín; Cabrera-Rojas, Jesús; Guzmán-Flores, Gerardo; Estrada-Lobato, Enrique; Cano-Valdés, Ana María; Santamaría-Linares, Erik

    2011-01-01

    Bone reconstruction is a common problem in the oncological setting. Mandibular reconstruction is done with microvascularized free flaps, but noticeable differences in shape and size exist in relation to the normal mandible; consequently, new reconstructive methods are desirable. We explored the feasibility of recovering osseous viability using a sterilized mandibular segment reconstituted with autologous bone marrow. A 6- to 7-cm mandibular segment was excised in three Creole dogs. The segment was autoclaved for 40 min. The bone was then drilled, producing 3-mm holes every 10-mm. Bone was reconstituted with autologous bone marrow from the iliac spine mixed with particulated bone. Bone autograph was installed underneath the latissimus dorsi muscle. On week four after surgery, dogs received colloidal rhenium and were placed in a gamma camera. The study showed uptake of the radiotracer in the bone graft, demonstrating viability of bone marrow. One hour later, the autograph was excised in two dogs and a histopathological study corroborated the viability of the bone marrow and the formation of new vessels and osteoid. On week twelve, the third dog was administered MDP-99Tc and placed in a gamma camera. Results proved production of new bone. Osseous reconstruction with microvascularized flaps may cause problems, but sterilized bone reconstituted with bone marrow becomes viable. This observation eventually would allow osseous reconstruction, including the mandibule, easily and reliably in patients with osseous tumors. Autoclaved bone reconstituted with bone marrow recovers its viability.

  9. Integrated metabolomic and transcriptome analyses reveal finishing forage affects metabolic pathways related to beef quality and animal welfare

    PubMed Central

    Carrillo, José A.; He, Yanghua; Li, Yaokun; Liu, Jianan; Erdman, Richard A.; Sonstegard, Tad S.; Song, Jiuzhou

    2016-01-01

    Beef represents a major dietary component and source of protein in many countries. With an increasing demand for beef, the industry is currently undergoing changes towards naturally produced beef. However, the true differences between the feeding systems, especially the biochemical and nutritional aspects, are still unclear. Using transcriptome and metabolome profiles, we identified biological pathways related to the differences between grass- and grain-fed Angus steers. In the latissimus dorsi muscle, we have recognized 241 differentially expressed genes (FDR < 0.1). The metabolome examinations of muscle and blood revealed 163 and 179 altered compounds in each tissue (P < 0.05), respectively. Accordingly, alterations in glucose metabolism, divergences in free fatty acids and carnitine conjugated lipid levels, and altered β-oxidation have been observed. The anti-inflammatory n3 polyunsaturated fatty acids are enriched in grass finished beef, while higher levels of n6 PUFAs in grain finished animals may promote inflammation and oxidative stress. Furthermore, grass-fed animals produce tender beef with lower total fat and a higher omega3/omega6 ratio than grain-fed ones, which could potentially benefit consumer health. Most importantly, blood cortisol levels strongly indicate that grass-fed animals may experience less stress than the grain-fed individuals. These results will provide deeper insights into the merits and mechanisms of muscle development. PMID:27185157

  10. An Analysis of Muscle Activities of Healthy Women during Pilates Exercises in a Prone Position.

    PubMed

    Kim, Bo-In; Jung, Ju-Hyeon; Shim, Jemyung; Kwon, Hae-Yeon; Kim, Haroo

    2014-01-01

    [Purpose] This study analyzed the activities of the back and hip muscles during Pilates exercises conducted in a prone position. [Subjects] The subjects were 18 healthy women volunteers who had practiced at a Pilates center for more than three months. [Methods] The subjects performed three Pilates exercises. To examine muscle activity during the exercises, 8-channel surface electromyography (Noraxon USA, Inc., Scottsdale, AZ) was used. The surface electrodes were attached to the bilateral latissimus dorsi muscle, multifidus muscle, gluteus maximus, and semitendinous muscle. Three Pilates back exercises were compared: (1) double leg kick (DLK), (2) swimming (SW), and (3) leg beat (LB). Electrical muscle activation was normalized to maximal voluntary isometric contraction. Repeated measures analysis of variance was performed to assess the differences in activation levels among the exercises. [Results] The activity of the multifidus muscle was significantly high for the SW (52.3±11.0, 50.9±9.8) and LB exercises(51.8±12.8, 48.3±13.9) and the activity of the semitendinosus muscle was higher for the LB exercise (49.2±8.7, 52.9±9.3) than for the DLK and SW exercises. [Conclusion] These results may provide basic material for when Pilates exercises are performed in a prone position and may be useful information on clinical Pilates for rehabilitation programs.

  11. Forelimb kinematics and motor patterns of the slider turtle (Trachemys scripta) during swimming and walking: shared and novel strategies for meeting locomotor demands of water and land

    PubMed Central

    Rivera, Angela R. V.; W. Blob, Richard

    2010-01-01

    Turtles use their limbs during both aquatic and terrestrial locomotion, but water and land impose dramatically different physical requirements. How must musculoskeletal function be adjusted to produce locomotion through such physically disparate habitats? We addressed this question by quantifying forelimb kinematics and muscle activity during aquatic and terrestrial locomotion in a generalized freshwater turtle, the red-eared slider (Trachemys scripta), using digital high-speed video and electromyography (EMG). Comparisons of our forelimb data to previously collected data from the slider hindlimb allow us to test whether limb muscles with similar functional roles show qualitatively similar modulations of activity across habitats. The different functional demands of water and air lead to a prediction that muscle activity for limb protractors (e.g. latissimus