Abstract
Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.
Highlights
Breast cancer is one of the most common cancers, accounting for over 30% of all cancers in women
Fourteen out of 16 latissimus dorsi (LD) muscles exhibited intramuscular nerve arborization most extensive at the medial and lateral sections with 40–60%, middle region with 30–60% and medial, middle and lateral parts with 70–90%, regarding the medial side of the surgical neck of the humerus to the line crossing the spinous process of T5 to the middle of the iliac crest (Figure 1)
Fourteen of the 16 LD muscles had the nerve entry point at the medial and lateral part with 20–40%, regarding the medial side of the surgical neck of the humerus and the line crossing the spinous process of T5 to the middle of the iliac crest
Summary
Breast cancer is one of the most common cancers, accounting for over 30% of all cancers in women. The total number of mastectomy patients who opt to undergo post-mastectomy breast reconstruction continues to grow [2]. Breast reconstruction using latissimus dorsi (LD) flap is a commonly used autologous implant substance [3,4,5,6,7,8,9]. The leading cause of the pain in the flap is muscular contraction and spasms after the transplantation surgery [12,13,14]. Prior studies have reported that BoNT injections after harvesting the flap by free hand or neurolysis in patients with myocutaneous flap reconstruction surgery, significantly eases muscular contraction and reduces the patient’s pain [7,15,16,17,18]. Researches have stated definite consequences of BoNT on flap survivability and tissue blood flow [20,21,22]
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