Combined Muscle Flap Research Articles

Y-shaped Muscular Wrapping Technique Avoiding Re-infection of a Replaced Aortic Graft: A Cadaveric Study.

Summary:Replacing an infected prosthetic thoracic aorta graft carries a high re-infection risk. We previously reported two clinical cases successfully treated with a new muscular wrapping technique: latissimus dorsi (LD) muscle flap with a distally based serratus anterior (SA) extension; however, a cadaveric study to prove the regular existence of the distal attachment area was lacking. We tried to establish an appropriate way of elevating the combined muscle flap safely. All of the cadavers were preserved using the Thiel embalming technique to retain flexibility. We checked for the existence of the distal attachment area between the LD and SA. Combined muscle flaps were elevated proximally while identifying the thoracodorsal artery, including the LD and SA branches. After the SA branch was ligated and cut, the SA muscle was manually peeled from the LD muscle with only the distal tight attachment area remaining. Contrast-enhanced computed tomography was performed using a multislice computed tomography system. Six human cadavers (three men, three women: 91 years old, on average) were examined. All six LD and SA combined muscle flaps showed a distal tight attachment area at the level from the seventh rib to the ninth rib. The tip of the SA muscle easily reached the sternum. Contrast-enhanced computed tomography failed to reconfirm the distal vascular flow from the LD to the reverse SA muscle, which we had visualized in a clinical case. We demonstrated the anatomical reliability of the new Y-shaped muscular flaps, which are suitable for preventing re-infection of aortic graft replacement.

One-stage free transfer of latissimus dorsi-serratus anterior combined muscle flap with dual innervation for smile reanimation in established facial paralysis

Microneurovascular free muscle transfer is the gold-standard surgical procedure for the reanimation of established facial paralysis. However, the innervation of the transferred muscle by the contralateral facial nerve is usually insufficient to produce a stable smile. Besides, the corner of the mouth sometimes moves unnaturally as if it were being pulled up because of the single-direction movement. Thus, we propose one-stage facial reanimation using free latissimus dorsi (LD)-serratus anterior (SA) combined muscle flap transfer with dual innervation. The LD-SA combined muscle flap was harvested with the thoracodorsal artery and vein as common vessels to move the corner of the mouth bidirectionally for natural smiling. The LD muscle was located in the same direction as the zygomaticus major muscle and reinnervated by dual innervation. The contralateral facial nerve was coapted with the thoracodorsal nerve, and the ipsilateral masseter motor nerve was inserted into the LD muscle by intramuscular neurotization. The 6th or 7th SA muscle was located in the same direction as the risorius muscle and reinnervated by neurorrhaphy of the long thoracic nerve and the thin branch of the ipsilateral masseter motor nerve. Since 2015, seven patients have been treated with this method without complications. On average, SA muscle movement was detected in voluntary biting at 3.1 months, and spontaneous smiling occurred 7.7 months after surgery. All patients developed a spontaneous natural smile. This method for established facial paralysis has the potential to improve the quality of the reconstructed smile and the unstable results of conventional single-innervation-single-muscle transfer.

褥瘡に起因する両側化膿性股関節炎を，Girdlestone手術および連合筋皮弁移植を用いて治癒させた 1 例

褥瘡に起因する両側化膿性股関節炎を，Girdlestone手術および連合筋皮弁移植を用いて治癒させた 1 例

Immediate implanting breast reconstruction with combined muscle flap of pedicled latissimus dorsi and pectoralis major muscle

Objective To explore immediate implanting breast reconstruction after subcutaneous mastectomy by through breast lateral curved incision with combined muscle flap of pedicled latissimus dorsi and pectoralis major muscle covering the breast prosthesis. Methods 30 patients were selected in clinical stage Ⅰ or Ⅱ , and without involvement of skin and pectoral muscle. After subcutaneous mastectomy through breast lateral curved incision, by the same incision the latissimus dorsi muscle flap was removed and transferred, and the submuscular interspace was dissected, and the inferior border of the pectoralis major muscle was cut off. The pedicled latissimus dorsi and pectoralis major muscle flap were sutured and the combined muscle flap was formed to cover the breast prothesis.Results The shape and feeling were satisfactory in 30 reconstructive breasts, and 22 cases were excellent (73.3 %), and 8 cases were good (26.7 %). All the patients survived without tumor recurrence after following-up more than half a year. Conclusions The method has advantages of good cosmetic breast shape, without appendant incision, and larger breast prosthesis could be insertted. It is a good method of immediate breast reconstruction for the young women with early stage breast cancer without axillary lymph node metastasis. Key words: Breast prothesis; Breast reconstruction; Subcutaneous mastectomy; Combined muscle flap

Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects.

Thirty-six patients were treated by Ilizarov transport in conjunction with muscle and myocutaneous flaps coverage. Thirty-one free flaps and 5 rotation flaps were performed. In 13 patients the procedures were carried out in 1-stage or simultaneous manner. In 23 patients, soft tissue coverage proceeded as the initial step followed by Ilizarov reconstruction as a delayed procedure. All flaps survived the simultaneous and delayed procedures and there were no anastomotic complications, but partial flap necrosis occurred in 1 patient 3 months after the index procedure at the time of flap elevation for docking site bone graft placement. The mean segmental defects were 10 cm and 5.8 cm for the simultaneous and delayed groups, respectively. The followup interval from the time of free flap coverage ranged from 2 to 44 months in the simultaneous group with a mean and median of 22 and 24 months, respectively. Twelve patients completed treatment in the simultaneous group with the followup interval from frame removal ranging from 3 to 36 months with a mean and median of 18 and 14 months, respectively. In the delayed group this interval ranged from 1 to 36 months, with a mean and median of 16 and 12 months, respectively, and a mean and median of 24.5 and 21 months, respectively, from the time of the index procedure. Union and absence of infection were achieved in 35 of 36 patients presenting with an acute open fracture, infected nonunion, or aseptic nonunion without stable soft tissue coverage. The Ilizarov fixators remained in place for a median of 9.5 months for the simultaneous group and 8.5 months for the delayed group. When soft tissue defects accompany an infected nonunion or high grade open fracture, the traditional Ilizarov treatment approach of soft tissue recruitment into the wound from the distant corticotomy site is inconsistent with the proven benefit of early soft tissue coverage. The combined approach provides a more reliable soft tissue bed for early cancellous bone grafting of the docking site and permits the accurate restoration of limb length for these very difficult problems.

Eleven Consecutive Combined Latissimus Dorsi and Serratus Anterior Free Muscle Transplantations

We reviewed our experience with 11 consecutive combined latissimus dorsi and serratus anterior free-muscle transplantations from 1980 to 1990. All 11 flaps were successful and there was minimal morbidity. This combined muscle flap is ideal for soft-tissue coverage in extensive lower extremity wounds, in mutilating hand injuries with dorsal and palmar defects, and in situations when a long vascular pedicle is needed to get out of the "zone of injury."