Controlled muscle division during flap surgery: a simple technique

Abstract

Tissue transfer for breast reconstruction surgery using latissimus dorsi and transverse rectus abdominis myocutaneous flaps requires a degree of muscle cutting. Whether free or pedicled flaps are performed, muscles are divided and cauterised to obtain the desired tissue volume. Standard techniques of muscle cutting include monopolar or bipolar diathermy, whose electrical impulses mimic action potentials causing excessive muscle twitching. This can lead to irregular planes of dissection, potential damage to delicate perforating vessels, and difficult haemostasis. We propose localised infiltration of 0.25% bupivicaine into the muscle prior to diathermy division. This technique reliably prevents excess muscle twitching and permits controlled dissection in the desired plane. Comparative video clips of this technique are available as supplementary material. Although the ideal method for tissue transfer in breast reconstruction is to avoid muscle cutting altogether by using free tissue transfer of perforator flaps, in units where these methods are not standard it may become necessary to convert to a muscle-sparing or pedicled-flap technique, thereby necessitating a degree of muscle cutting. Whether division of muscle is preferable or not, it is occasionally unavoidable, and our proposed technique will make the process of muscle division simpler and more controlled.