The Use of Muscle-Sparing Latissimus Dorsi Myocutaneous Flap (MSLD) to Minimize Functional Morbidity in Patients with Post Burn Breast Deformities | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 8, Volume 49, Issue 1, January 2025, Pages 57-64 PDF (577.09 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2025.405211 | ||
| Authors | ||
| Rama Ali* 1; ahmed Gamal Hemidan* 2; Dina H Gamal El Din3; Nancy Shehta3; Ayman Noaman1 | ||
| 1The Department of Plastic Surgery, Faculty of Medicine, Cairo University | ||
| 2Department of Plastic Surgery, Zayed Hospital, Cairo, Egypt | ||
| 3Department of Physiotherapy, Faculty of Medicine, Cairo University | ||
| Abstract | ||
| Background: The Latissimus dorsi (LD) flap plays a crucial role in breast reconstruction, particularly for post-mastectomy patients or those dealing with post-burn deformities. The pedicled LD emerges as a dependable option for restoring volume and in inframammary fold reconstruction in post-burn patients. Nevertheless, a comprehensive assessment of its potential long-term functional effects is imperative prior to opting for the pedicled LD in breast reconstruction. Objective: This study aims to evaluate the functional outcomes and patient satisfaction in breast reconstruction using the (LD) flap versus the (MSLD) flap in post-burned patients. Methodology: In this Ambidirectional Cohort Study (Combined retrospective and prospective cohort study), we enrolled twenty-four female patients who already underwent correction of post burn breast deformities to address post-burn breast deformities between 2020 and 2022. The included patients were divided into two groups; group I: (14 patients) with traditional latissimus dorsi LD flap, group II (10 patients): Underwent MSLD flap. Patient satisfaction was assessed using the Breast Q questionnaire, we also used the Western Ontario Shoulder Instability Index (WOSI) to evaluate shoulder function scores, and the functional assessment involved both objective measures, such as geometric measurements of shoulder range of movement and radiological assessment of the acromion- humeral interval (AHI). Results: Concerning the Breast Q and WOSI results, there was statistically significant greater satisfaction in the MSLD flap group. As regarding the deficit in the range of shoulder movement and the AHI measurements, no statistically significant differences were observed between both groups, however, the MSLD flap group exhibited superior results. Conclusion: For post-burn breast reconstruction, MSLD should be preferred, especially for younger patients. If MSLD is impractical, traditional LD is an acceptable alternative but with shoulder limitations lasting up to 6 months post-surgery. Preoperative imaging to identify abnormal AHI, thus, preventing shoulder impingement and initiating early postoperative shoulder exercises would help to achieve better outcomes. | ||
| Keywords | ||
| Latissimus dorsi – Breast; reconstruction – Functional | ||
| References | ||
|
MacLennan S.E., Wells M.D. and Neale HW.: Reconstruction of the burned breast. Clin. Plast. Surg., 27 (1): 113- 119, 2000. 2- Ozgur F., Gokalan I., Mavili E., Erk Y. and Kecik A.: Reconstruction of postburn breast deformities. Burns, 18 (6): 504-509, 1992. doi:https://doi.org/10.1016/0305- 4179(92)90186-X. 3- Clough K.B., Louis-Sylvestre C., Fitoussi A., Couturaud B. and Nos C.: Donor Site Sequelae after Autologous Breast Reconstruction with an Extended Latissimus Dorsi Flap. Plast Reconstr Surg., 109 (6), 2002. https://journals. lww.com/plasreconsurg/fulltext/2002/05000/donor_site_ sequelae_after_autologous_breast.20.aspx. 4- Saint-Cyr M., Nagarkar P., Schaverien M., Dauwe P., Wong C. and Rohrich R.J.: The pedicled descending branch muscle-sparing latissimus dorsi flap for breast reconstruction. Plast. Reconstr. Surg., 123 (1): 13-24, 2009. doi:10.1097/PRS.0b013e3181934838. 5- Salomonsson B., Ahlström S., Dalén N. and Lillkrona U.: The Western Ontario Shoulder Instability Index (WOSI): Validity, reliability, and responsiveness retested with a Swedish translation. Acta. Orthop., 80 (2): 233-238, 2009. doi:10.3109/17453670902930057. 6- Liu L.Q., Branford O.A. and Mehigan S.: BREAST-Q measurement of the patient perspective in oncoplastic breast surgery: A systematic review. Plast Reconstr Surg - Glob Open., 6 (8): 1-8, 2018. doi:10.1097/ GOX.0000000000001904. 7- CHAN Y.H.: Biostatistics 102: quantitative data--parametric & non-parametric tests. Singapore Med. J., 44 (8): 391- 396, 2003. 8- Spear S.L. and Hess C.L.: A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles. Plast. Reconstr. Surg., 115 (7): 2070-2073, 2005. doi:10.1097/01. PRS.0000163329.96736.6A. 9- Kim H., Wiraatmadja E.S., Lim S.Y., et al.: Comparison of morbidity of donor site following pedicled muscle-sparing latissimus dorsi flap versus extended latissimus dorsi flap breast reconstruction. J. Plast. Reconstr. Aesthetic Surg., 66 (5): 640-646, 2013. doi:10.1016/j.bjps.2013.01.026. 10- Glassey N., Perks G.B. and McCulley S.J.: A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction. Plast. Reconstr Surg., 122 (5): 1334-1340, 2008. doi:10.1097/ PRS.0b013e3181881ffe. 11- Koh C.E. and Morrison W.A.: Functional impairment after latissimus dorsi flap. ANZ J. Surg., 79 (1-2): 42-47, 2009. doi:10.1111/j.1445-2197.2008.04797.x. 12- Forthomme B., Heymans O., Jacquemin D., et al.: Shoulder function after latissimus dorsi transfer in breast reconstruction. Clin. Physiol. Funct Imaging, 30 (6): 406-412, 2010. doi:10.1111/j.1475-097X.2010.00956.x. 13- Hamdi M., Decorte T., Demuynck M., et al.: Shoulder function after harvesting a thoracodorsal artery perforator flap. Plast. Reconstr. Surg., 122 (4): 1111-1117, 2008. doi:10.1097/PRS.0b013e31818459b4. 14- Goutallier D., Le Guilloux P., Postel J.M., Radier C., Bernageau J. and Zilber S.: Acromio humeral distance less than six millimeter: Its meaning in full-thickness rotator cuff tear. Orthop. Traumatol. Surg. Res., 97 (3): 246-251, 2011. doi:10.1016/j.otsr.2011.01.010. | ||
|
Statistics Article View: 104 PDF Download: 153 |
||
