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Background: The latissimus dorsi pedicled (LAT) flap has been a workhorse flap for breast reconstruction for many decades. The asymmetric back scar has been a major source of complaint. In patients with excess back adiposity, we can utilize the skin paddle harvest to improve back contour. We combined the principles of the aesthetic bra-line back lift with the LAT flap to provide simultaneous improvement of both posterior upper trunk adiposity and skin excess, which together form "back rolls," with a concealed scar., Objectives: The objective was to establish a new surgical technique of combined bra-line back lift with latissimus dorsi flap (BLBL-LAT flap) for aesthetic breast reconstruction., Methods: This was an IRB-approved retrospective single-surgeon study performed in a national cancer center. We included patients undergoing breast reconstruction with the combined BLBL-LAT flap between 2015 and 2023, with a minimum of 6 months of follow-up., Results: A total of 106 female patients underwent 110 breast reconstructions with the BLBL-LAT flap. Seventy-five percent of patients had prosthesis placement and 25% of patients were 100% autologous. Complication rates were low: 4 of 106 patients (3.8%) had seroma, needing surgery. Of the 78 reconstructions with implants or tissue expanders, 3 (3.8%) had a periprosthetic infection. One (<1%) patient had partial flap loss, and no patients had complete flap loss. Four patients had bilateral BLBL-LAT flap reconstruction. Two unilateral breast reconstruction patients came back for successful symmetrizing of the bra-line back lift (without LAT flap breast reconstruction)., Conclusions: The BLBL-LAT flap allows breast reconstruction and simultaneous improvement of back contour, leaving a scar that can be concealed in a bra. This 2-for-1 procedure is of particular benefit to patients with a high BMI, who often have unwanted excess adiposity and laxity of the back. Because this patient population is at high risk for free tissue transfer, we propose that the BLBL-LAT flap be considered the first-line method of autologous breast reconstruction in higher BMI patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results., Purpose: To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs)., Study Design: Case series; Level of evidence, 4., Methods: Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed., Results: A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm., Conclusion: At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was received from GCS Ramsay Santé pour l’Enseignement et la Recherche. J.K. has received royalties from FH Orthopedics, and personal fees from VIMS outside the submitted work. J.G. has received royalties from Zimmer Biomet and is a consultant for Smith & Nephew outside the submitted work. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Introduction: This study aims to establish, execute, and assess the effectiveness of a perioperative enhanced recovery after surgery (ERAS) clinical care pathway in breast reconstruction patients with LD flap breast cancer treatment. The goal is to improve early recovery outcomes, reduce hospitalization time, and enhance patient satisfaction by implementing a standardized approach to postoperative care., Methods: This study was conducted at the University of Malaya Medical Center. The outcomes of 21 breast cancer patients who underwent autologous reconstructive breast surgery with the latissimus dorsi (LD) flap within six months before the implementation of the ERAS pathway (pre-ERAS) were compared with 26 patients who underwent the same surgery with the ultrasound-guided erector spinae plane (ESP) block for the (ERAS protocol implementation) cohort. The study was conducted from November 2019 to October 2020. The length of hospital stay, amount of analgesic usage, and incidence of postoperative nausea vomiting (PONV) were recorded., Results: The implementation of the ERAS clinical care pathway resulted in shorter hospital stays compared with the preceding care. On average, ERAS patients were mostly discharged on Day 2 post-surgery, whereas pre-ERAS patients were mostly discharged on Day 7. ERAS patients had a lower incidence of PONV from Days 1 to 5, starting with 88.5% not experiencing the condition on Days 1 and 2 and increasing to 100% on Day 5. All pre-ERAS patients experienced PONV in the first 5 days post-surgery. Fewer ERAS patients required antiemetics post-surgery (88.5%) compared with pre-ERAS patients (42.9%)., Conclusion: The implementation of the ERAS protocol as part of clinical care in autologous reconstructive breast surgery with the LD flap can improve recovery by shortening hospital stay, decreasing the use of analgesia, and alleviating PONV., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: Tendon transfers are established techniques to regain external rotation mobility in patients with an irreparable, posterosuperior massive rotator cuff tear (MRCT). Posterosuperior MRCT with intact teres minor (type D MRCT) can lead to excessive teres minor loading to maintain external rotation. We hypothesize that tendon transfers are effective in relieving teres minor loading in type D MRCTs. Our aim was to biomechanically assess muscle synergism with latissimus dorsi (LD transfer) and lower trapezius (LT transfer) tendon transfer during external rotation at different abduction heights., Methods: Using musculoskeletal modeling, we analyzed and compared the moment arm, muscle torque, and muscle activity between a healthy and type D MRCT pathologic model with and without the LD- or LT transfer at infraspinatus and teres minor insertion sites. Output measures were analyzed during external rotation at different abduction angles and 10-50 N resistance against external rotation. We assessed its impact on teres minor loading in a type D MRCT. Morphologic variations were parameterized using the critical shoulder angle and the acromiohumeral distance to address variations among patients., Results: Both transfer types reduced teres minor torque and activity significantly, reaching physiological state at 40 N external resistance (P < .001), with insertion to infraspinatus site being more effective than teres minor site (P < .001). External rotation moment arms of LD transfer were larger than LT transfer at 90° abduction (25.1 ± 0.8 mm vs. 21.2 ± 0.6 mm, P < .001) and vice versa at 0° abduction (17.4 ± 0.5 mm vs. 24.0 ± 0.2 mm, P < .001). Although the healthy infraspinatus was the main external rotator in all abduction angles (50%-70% torque), a type D MRCT resulted in a 70%-90% increase of teres minor torque and an up to 7-fold increase in its activity leading to excessive loadings beyond 10 N resistance against external rotation. Varying the critical shoulder angle and the acromiohumeral distance led to minor variations in muscle moment arm and muscle activity., Conclusion: We identified biomechanical efficacy of both tendon transfers in type D MRCT regarding teres minor load relief and superior performance of the transfers at the infraspinatus insertion site., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation., Materials and Methods: This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results., Results: The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%)., Conclusion: Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction., Competing Interests: Declarations Ethical approval and concent to participate All procedures in the current study were conducted according to the Declaration of Helsinki. The faculty of medicine, Cairo University’s ethical committee approved all experimental protocols. Informed consent was obtained from each of the patients’ legal guardians. Compliance with ethical standards Ethical committee contact details: Faculty of Medicine, Cairo University, Egypt (telephone: +201003657120, kasralainirec@yahoo.com, https://medicine.cu.edu.eg/index.php/en/postgraduate/32-research/161-research-ethics-committee). Concent for publication Patients’ legal guardians signed informed consent to publish their data and photographs showing human faces. Clinical trial number not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Patients with brachial plexus birth injuries (BPBIs) are at risk for limitations in shoulder external rotation. The role of lower trapezius tendon transfer to restore shoulder external rotation in this population has not been well characterized. This study aimed to evaluate the utility of lower trapezius tendon transfer for restoration of external rotation in a subset of pediatric patients., Methods: Seventeen pediatric patients with BPBI were treated with lower trapezius tendon transfer to restore external rotation of the shoulder. Mean age at surgery was 8 years, and 11 were female. Six patients had prior shoulder surgery to restore external rotation, while 1 had prior nerve surgery to restore shoulder function. Range of motion before lower trapezius transfer and at latest follow-up was obtained. Mean follow-up was 36 months., Results: Active forward flexion did not significantly change from preoperative to final follow-up (mean, 147° and 141°; P = 0.46). External rotation in adduction significantly changed from preoperative to final follow-up (mean, 4° and 26°; P < 0.001). External rotation in abduction significantly changed from preoperative to final follow-up (mean, 75° and 84°; P = 0.048). Six patients (35%) had subsequent surgeries at average 17 months from this procedure. Significant univariate associations with subsequent surgery included certain intraoperative concomitant procedures-coracoid osteotomy/excision (P = 0.02) and biceps tenodesis (P = 0.04)-while bony glenoid augmentation/reconstruction trended toward significant association (P = 0.05)., Conclusions: Lower trapezius tendon transfer for BPBI showed a statistically significant but unlikely clinically meaningful improvement in external rotation with a high rate of reoperation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Breast animation is a common postoperative complication of breast reconstruction surgery. This study investigates the factors affecting the onset and degree of animation to suggest an ideal treatment strategy for this complication., Methods: This study included patients who underwent latissimus dorsi reconstruction at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, between 2009 and 2020 and had an outpatient visit after July 2020. Statistical analysis was performed and the patients' background and surgical factors were examined to determine whether they affected the animation incidence rate., Results: The animation incidence rate was 69.6%. There was no significant relationship between animation incidence and any patient background or surgical factors, except for the complete dissection of insertion into the humerus of the latissimus dorsi muscle (p = 0.0039). The rate of uncomfortable animation was 4% and recurrence of animation was observed in one of the two patients who underwent denervation., Conclusion: Prophylactic denervation is not considered necessary and should be offered only for persistent discomfort with animation. Instead, the muscle insertion must be dissected during flap elevation to prevent animation, and the thoracodorsal nerve must be preserved to avoid muscle atrophy.

Background: Irreparable anterosuperior rotator cuff tears (IASRCTs) present significant challenges, especially in young, active patients with limited joint-preserving options. Recently, latissimus dorsi (LD) transfer and combined latissimus dorsi and teres major (LDTM) transfer have gained attention as a potential surgical option. We aimed to compare the clinical and radiological outcomes of LD versus combined LDTM transfer in IASRCTs., Methods: In this retrospective comparative study, 53 patients with IASRCTs were analyzed after undergoing either LD transfer attached to lesser tuberosity (LT) (LD group, n = 23) or combined LDTM transfer attached to greater tuberosity (GT) (LDTM group, n = 30). Clinical evaluations included the visual analog scale score for pain, active shoulder range of motion (ROM), University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons score, activities of daily living that require active internal rotation (ADLIR) scores, and subscapularis (SSC)-specific examinations. Radiographic analyses involved assessing acromiohumeral distance (AHD), Hamada grade, the rate of anterior glenohumeral subluxation reduction, and integrity of the transferred tendon., Results: Postoperatively, both groups demonstrated significant improvements in pain and clinical scores ( p < 0.001). At the 2-year follow-up, the LDTM group showed superior internal rotation strength ( p < 0.001), ADLIR score ( p = 0.017), and SSC-specific physical examination results (belly-press, p = 0.027; bear-hug, p = 0.031; lift-off, p = 0.032). No significant changes in AHD or Hamada grade were observed in either group. At final follow-up, no significant differences were found between the 2 groups in terms of AHD ( p = 0.539) and Hamada grade ( p = 0.974). Although preoperative anterior glenohumeral subluxation was improved in both groups, the LDTM group showed a statistically significantly higher rate of restoration compared to the LD group ( p = 0.015)., Conclusions: While both LD and combined LDTM transfers for IASRCTs improved postoperative pain relief, clinical scores, and active ROM, the combined LDTM transfer attached to GT was superior to LD transfer attached to LT in terms of internal rotational strength, ADLIR score, and SSC-specific examinations. Neither group showed significant progress in cuff tear arthropathy or decreased AHD at 2-year follow-up; however, the combined LDTM transfer notably improved preoperative anterior glenohumeral subluxation., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Background: Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared with implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to nonmicrosurgeons. This study compared the 2 procedures concerning their clinical and patient-reported outcomes 1 year postoperatively., Methods: The authors conducted a retrospective review of LIFTs and Ab-FFs performed between March of 2017 and August of 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Satisfaction with Abdomen, Satisfaction with Back, Psychosocial Well-being, Physical Well-being: Chest, Physical Well-being: Abdomen, Physical Well-being: Back, and Sexual Well-being., Results: Of the 281 included patients (408 breasts), 211 received Ab-FF and 70 received LIFT. One-year follow-up (median [interquartile range], 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. Obesity predicted dehiscence, and bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by 1 year postoperatively., Conclusions: Although Ab-FF is the standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can be used by plastic surgeons who are not trained in microsurgical procedures or do not have an environment that fosters Ab-FF., Clinical Question/level of Evidence: Therapeutic, III., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Variant anatomy in the axillary region is of great clinical significance. It is one of the most frequently accessed regions for radical dissection surgery. During routine dissection of embalmed cadavers, we found a rare case of two accessory muscular slips emerging from the lateral border of latissimus dorsi (LD) and the inferolateral border of pectoralis major (PM), crossing the neurovascular structures in the axilla and merging distally together to the brachial fascia at the upper end of humerus below the bicipital groove. The accessory slip from LD is commonly referred to as the "axillary arch" in literature. We identified the accessory slip from the PM crossing over the axilla as pectoralis quartus. These aberrant slips can cause neurovascular compression in the axilla and can have clinical implications. Prior knowledge of the variant anatomy is the key to successful surgery in the axilla, thereby avoiding inadvertent injuries and post-operative complications., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: With 60,000 cases per year, breast cancer is the most frequent type of cancer in France, and a quarter of these cases require mastectomy. Following the surgery, breast reconstruction can be indicated. Two of the available techniques are breast implants (BIs) and muscle-sparing latissimus dorsi (MSLD). The aim of this study was to compare postoperative complications of each approach and thus help the surgeon and the patient in making an informed decision before surgery., Materials and Methods: This descriptive, retrospective and single-centre study was conducted in the Croix Rousse hospital in Lyon (France) between 1 July 2018 and 1 July 2023. It included women aged ≥18 years who underwent mastectomy followed by (immediate or delayed) breast reconstruction with MSLD or BI. Complications were recorded and evaluated using the Clavien-Dindo classification., Results: Over the course of the study, 92 patients were managed with MSLD reconstruction and 63 patients with BI. We observed a complication rate of 62% in the BI group and 39% in the MSLD group (odds ratio [OR]=0.16; p < 0.005). Body mass index (BMI) significantly impacted this rate (OR=1.11; p = 0.01), whereas smoking status and diabetes did not. No complication occurred more predominantly than others. A second surgery was required more often in the BI group (p < 0.005). There were no severe complications (>Grade 4)., Conclusion: MSLD predicted fewer complications and was associated with a shorter hospital stay compared with implants, suggesting that it may be a preferable option for breast reconstruction., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children and adolescents. Around 35 % of pediatric sarcomas occur in the head and neck region. Consequently, RMS is considered the most common type of childhood malignancy diagnosed in this region., Observation: We report the clinical case of a 6 years old patient, who presented a large temporal hollowing following oncological excision surgery for temporal rhabdomyosarcoma. He underwent surgical reconstruction to fill the right temporalis fossa using a latissimus dorsi muscle free flap micro-anastomosed to the lingual vessels., Discussion: This clinical case highlights the value of plastic surgery in oncological reconstruction, which, combined with a multidisciplinary and collective approach, enables a holistic approach and facilitates socio-psychological integration after oncological surgery in the pediatric population., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Summary: Various neurovascular free muscle transfers for smile reconstruction in patients with facial paralysis have been reported. However, these methods focused on perioral smiling rather than eye smiling. Although the lower eyelid does not contribute significantly to eyelid closure, dynamic reanimation of the upward movement of the lower eyelid with bulging of the malar region during smiling is important in smile reconstruction. The authors present a novel procedure for smiling eye and perioral smiling. The V-shaped latissimus dorsi muscle flap containing the descending branch (DB) of the thoracodorsal nerve (TDN) was used. Muscle A (15 to 17 cm), which is located along the main trunk of the DB, is much longer than muscle B (10 to 12 cm), which is along the branch of DB. A distal stump of the TDN involved in muscle B was prepared. The true trunk and distal stump of the TDN were sutured to the contralateral facial and ipsilateral masseteric nerves, respectively. The central region of muscle A was positioned at the lateral part of the lower eyelid; the distal end of long muscle A was affixed to the temporal region, which enabled periocular movements and narrowing of the palpebral fissures alongside perioral smiling when muscle A contracted. Nine patients with complete flaccid facial paralysis were treated. All patients attained muscle contraction induced by the ipsilateral masseteric and contralateral facial nerves. The smiling eye appearance was observed in 7 of 9 patients. This procedure simultaneously improves paralytic ectropion at rest and aids eyelid closure and enables early voluntary smile and a later spontaneous smile., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Abstract: The latissimus dorsi muscle or myocutaneous flap (LDMF) has long been a mainstay in the plastic surgeon's armamentarium, serving as a versatile and reliable tool for reconstructive procedures. Tunneling the LDMF through the subscapular route increases the reach to cover defects as far as nape of the neck. In this article, we report a case of LDMF routed through a subscapular route to cover impending hardware exposure at the nape region. This article provides a comprehensive review of the subscapular tunneled LDMF technique while discussing its indications, surgical anatomy, operative technique, complications, and outcomes., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients., Methods: This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10)., Results: There were significant improvements in clinical scores, in the range and strength of internal rotation and aROM compared with the preoperative values in the 26 patients (87%) who were available for long-term follow-up. These improvements were maintained between short- and long-term follow-ups. Although there was a decreased mean AHD of 7.3 mm (SD 1.5) and an increased mean Hamada grade of 1.7 (SD 0.5) at final follow-up, the rate of progression of cuff tear arthropathy remained low-grade. Comparison between the isolated SSC and combined SSC and reparable supraspinatus tear groups showed no significant differences. At final follow-up, one patient (3.8%) had undergone revision surgery to a reverse shoulder arthroplasty (RSA). No neurological complications were associated with the procedure., Conclusion: Latissimus dorsi transfer for an irreparable SSC tendon tear resulted in a significant clinical improvement, particularly in pain, range and strength of internal rotation and aROM, which were maintained over a mean of 8.7 years following surgery. Given that this was a long-term outcome study, there was a low-grade progression in the rate of cuff tear arthropathy. Thus, the long-term clinical efficacy of latissimus dorsi tendon transfer in patients with irreparable SSC was confirmed as a joint-preserving procedure for these patients, suggesting it as an effective alternative to RSA in young, active patients without degenerative changes of the glenohumeral joint., Competing Interests: None declared., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: Reverse shoulder arthroplasty (RSA) with concurrent latissimus dorsi transfer (LDT) is a potential treatment option for restoration of external rotation (ER). Biomechanical studies have emphasized the importance of the insertion site location for achieving optimal outcomes. In this systematic review and meta-analysis, we aimed to describe what insertion sites for LDT are utilized during concomitant RSA and their associated clinical outcomes., Methods: A systematic review and meta-analysis were performed per PRISMA guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on patients who received RSA with LDT to restore ER and specified the site of tendon transfer insertion on the humerus. We first describe reported insertion sites in the literature. Secondarily, we present preoperative and postoperative range of motion and Constant score for different insertion sites as well as reported complications., Results: Sixteen studies, analyzed as 19 separate cohorts (by insertion site and tendon-transfer), reporting on 264 RSAs with LDT (weighted mean age 66 years, follow-up 39 months, 61% female) were evaluated. Of these, 143 (54%) included a concomitant teres major transfer (LDT/TMT) and 121 (46%) were LDT-only. Fourteen cohorts (14/19, 74%) reported insertion at the posterolateral aspect of the greater tuberosity, four cohorts (4/19, 21%) reported insertion site at the lateral bicipital groove, and one cohort (1/19, 5%) reported separate LDT and TMT with insertion of the TMT to the posterolateral aspect of the greater tuberosity and LDT to the lateral bicipital groove. Meta-analysis revealed no differences in range of motion or Constant score based on humeral insertion site or whether the LDT was transferred alone or with TMT. Leading complications included dislocation, followed by infection and neuropraxia. No discernible correlation was observed between postoperative outcomes and the strategies employed for tendon transfer, prosthesis design, or subscapularis management., Conclusion: The posterolateral aspect of the greater tuberosity was the most-utilized insertion site for LDT performed with RSA. However, in the current clinical literature, LDT with or without concomitant TMT result in similar postoperative ROM and Constant score regardless of insertion site. Analysis of various proposed transfer sites reinforce the ability of LDT with RSA to restore both FE and ER in patients with preoperative active elevation and external rotation loss. Meta-analysis revealed significant improvements in range of motion and Constant score regardless of humeral insertion site or whether the LDT was transferred alone or with TMT, although future studies are needed to determine whether an ideal tendon transfer technique exists., Level of Evidence: IV., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: The optimal treatment protocol for open fractures with accompanying sizable soft tissue defect of the upper extremities has not been specifically delineated. The authors described the concurrent use of internal fixation and latissimus dorsi (LD) pedicle flap coverage in managing such complex fractures., Methods: Twenty patients with open fractures accompanied by large soft tissue defect of the upper extremities (8 clavicle fractures and 12 humeral fractures) were treated by fix & LD pedicle flap. The dimension of the defect, time to fix & flap, post-operative complications, time to union and clinical measurements were recorded., Results: The mean size of the defect was 132.45 cm 2 (range 6-12 x 2-20 cm 2 ). The average time to fix & flap was 9.9 days (range 7-14). Fractures union was achieved in all patients with an average duration of 18.5 weeks (range 14-28). Regarding post-operative complications, distal flap necrosis occurred in 3 patients, retained seroma in 3 and heterotopic ossification in 1. By the Mayo Elbow Performance (MEP) score, 3 cases were considered to be excellent, 6 were good, 7 were fair and 4 were poor. By the University of California-Los Angeles (UCLA) shoulder score, 2 cases were considered to be excellent, 7 were good, 7 were fair and 4 were poor. The average Disabilities of Arm, Shoulder and Hand (DASH) score was 31.29 (range 12.5-58.3)., Conclusion: Fix & LD pedicle flap is a reliable regimen for open fractures with sizable soft tissue defect of the clavicle and humerus., Competing Interests: Declaration of competing interest S. Jitprapaikulsarn, C. Patamamongkonchai, K. Sukha, A. Gromprasit and W. Thremthakanpon declare that they have no conflict of interest., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Latissimus Dorsi (LD) flap is at present among the best techniques for autologous breast reconstruction. A reliable pre-operatory estimation of flap volume would enhance surgical planning, thus improving the aesthetic outcomes of the reconstruction and reducing the need of secondary revision procedures. The study was aimed at providing a simple and reproducible formula to predict LD flap volume pre-operatively., Methods: 61 patients (66 flaps) who underwent breast reconstruction with LD flap at Policlinico Tor Vergata were prospectively enroled in the study. Anthropometric data and flap measurements were collected pre-operatively. LD flap volume was determined intraoperatively utilising a water displacement technique. A multivariate regression analysis was performed to analyse the collected data and to obtain the mathematical model that most accurately predicts flap volume., Results: The mean actual LD flap volume calculated through water displacement was 213.14 cc (SD 64.56). Performing a multivariate regression analysis BMI and skin paddle width emerged as the most accurate predictors of Latissimus Dorsi flap volume. The mean predicted LD flap volume (LD-V) using the LD-V formula was 213.19 cc (SD 54.59), with a strong Pearson correlation (r = 0.845; R 2 =0.715) with the volume calculated through the water displacement technique., Conclusions: The LD-V formula is an easy and reliable tool for LD flap volume assessment, available as 3.0 WebApp at www.braflap.com, that can be used as a valuable adjunct to surgeon's subjective evaluation to optimise breast reconstruction with the LD flap., Level of Evidence: II., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Partial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high-risk patients with complex laryngopharyngeal ± cutaneous neck defects., Methods: Retrospective single-surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck., Results: Twenty-four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo-esophageal peristomal fistulas. At last follow-up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G-tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post-operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively., Conclusions: The LDMFF can be a robust reconstructive option, particularly for radiated high-risk patients with complex pharyngeal defects, including skin., (© 2024 Wiley Periodicals LLC.)

Background: Although numerous treatments exist for the management of rectovaginal fistula, none has demonstrated its superiority. The role of diverting stoma remains controversial. A few series include Martius flap in the armamentarium., Objective: Determine the role of gracilis muscle interposition and Martius flap in the surgical management of rectovaginal fistula., Design: Retrospective cohort study of a pooled prospectively maintained database from 3 centers., Patients: All consecutive eligible patients with rectovaginal fistula undergoing Martius flap and gracilis muscle interposition were included from 2001 to 2022., Main Outcome Measures: Success was defined by the absence of stoma and rectovaginal fistula., Results: Sixty-two patients were included with 55 Martius flap and 24 gracilis muscle interposition performed after failures of 164 initial procedures. Total length of stay was longer for gracilis muscle interposition by 2 days ( p = 0.01) without a significant difference in severe morbidity (20% vs 12%, p = 0.53). Twenty-seven percent of the Martius flap interpositions were performed without a stoma, which did not have an impact on overall morbidity ( p = 0.763). Per patient immediate success rates were not significantly different between groups (35% vs 31%, p > 0.99). The success of gracilis muscle interposition after the failure of the Martius flap was not significantly different from an initial gracilis muscle interposition ( p > 0.99). After simple perineal procedures, the immediate success rate rose to 49.4% (49% vs 50%, p > 0.99). After a median follow-up of 23 months, no significant difference was detected in success rate between the 2 procedures (69% vs 69%, p > 0.99). Smoking was the only negative predictive factor ( p = 0.02)., Limitations: By its retrospective nature, this study is limited in its comparison., Conclusions: This novel comparison between Martius flap and gracilis muscle interposition suggests that Martius flap presents several advantages, including shorter length of stay, similar morbidity, and similar success rate. Proximal diversion via a stoma for Martius flap does not appear mandatory. Gracilis muscle interposition could be reserved as a salvage procedure after Martius flap failure. See Video Abstract ., Fstula Rectovaginal Cul Es El Rol Del Colgajo De Martius Y La Interposicin Del Msculo Gracilis En La Estrategia Teraputica: ANTECEDENTES:Si bien existen numerosos tratamientos para el manejo de la fistula rectovaginal, ninguno ha demostrado su superioridad. El papel del estoma de derivación sigue siendo controvertido. Pocas series incluyen colgajo de Martius en el armamento.OBJETIVO:Determinar el rol de la interposición del músculo gracilis y del colgajo de Martius, en el manejo quirúrgico de la fístula rectovaginal.DISEÑO:Estudio de cohorte retrospectivo de una base de datos mantenida prospectivamente en 3 centros.AJUSTES/PACIENTES:Se incluyeron todos los pacientes elegibles consecutivos con fistula rectovaginal sometidos a colgajo de Martius y la interposición del músculo gracilis desde 2001 hasta 2022.RESULTADOS PRINCIPALES:El éxito se definió por la ausencia de estoma y fistula rectovaginal.RESULTADOS:Se incluyeron 62 pacientes con 55 colgajo de Martius y 24 con interposición del músculo gracilis realizados después de fracasos de 164 procedimientos iniciales. La duración total de la estancia hospitalaria fue dos días más larga para la interposición del músculo gracilis ( p = 0,01) sin una diferencia significativa en la morbilidad grave (20% frente a 12%, p = 0,53). El 27% de los colgajos de Martius se realizaron sin estoma, sin impacto en la morbilidad global ( p = 0,763). Las tasas de éxito inmediato por paciente no fueron significativamente diferentes entre los grupos (35% vs. 31%, p = 1,0). El éxito de la interposición del músculo gracilis después del fracaso del colgajo de Martius no fue significativamente diferente de una interposición del músculo gracilis inicial (p = 1,0). La tasa de éxito inmediato aumentó al 49,4% (49% frente a 50%, p = 1,0) después de procedimientos perineales simples. Después de una mediana de seguimiento de 23 meses, no se detectaron diferencias significativas en la tasa de éxito entre los dos procedimientos (69 % frente a 69 %, p = 1,0). El tabaquismo fue el único factor predictivo negativo ( p = 0,02).LIMITACIONES:Por su naturaleza retrospectiva, este estudio tiene limitaciones en su comparación.CONCLUSIÓN:Esta novedosa comparación entre colgajo de Martius y la interposición del músculo gracilis sugiere que el colgajo de Martius presenta varias ventajas, incluida una estancia prolongada más corta, una morbilidad similar y un éxito. La derivación proximal a través de un estoma para el colgajo de Martius no parece obligatoria. La interposición del músculo gracilis podría reservarse como procedimiento de rescate después de una falla de colgajo de Martius. (Traducción-Dr. Aurian Garcia Gonzalez )., (Copyright © The ASCRS 2024.)

A desmoid tumour, also known as aggressive fibrous tumour or desmoid fibromatosis, is a rare, benign tumour originating from connective tissue cells. Desmoid tumours account for approximately 0.03+% of all neoplasms and less than 3+% of all soft tissue tumours. The estimated incidence in the general population is 2 to 4 cases per million people per year [1]. Desmoid tumours are characterised by aggressive growth but typically do not metastasize. They often occur in young adults and preferably affect specific body regions such as the abdomen, shoulder, chest, or extremities. The exact cause of the condition is not fully understood, but genetic changes and hormonal factors may play a role. Symptoms of a desmoid tumour depend on its location and size, with pain, swelling, or restricted movement commonly occurring. A diagnosis is typically made through a tissue sample (biopsy) and imaging techniques such as MRI or CT [2]. To our knowledge, this is the first documented case of recurrence of a desmoid tumour in the scar at the donor site of a latissimus dorsi flap previously used for the reconstruction of desmoid resection in the lower leg., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: This study presents preliminary results of robot-assisted nipple-sparing immediate breast reconstruction (R-NSMIBR) with gel implant combined with latissimus dorsi muscle flap without island flap and validation of the safety and utility of this novel surgical modality., Methods: Records pertinent to R-NSMIBR with gel implants combined with latissimus dorsi muscle flap surgery for breast reconstruction between September 2022 and May 2023 were examined. A total of 13 patients who underwent R-NSMIBR were analyzed, nine of which were performed without skin island., Results: We divided the patients with and without skin islands into two groups and recorded the operation time and bleeding respectively. The mean total operative time for R-NSMIBR was 436.5±56.88 minutes and 355.75±69.68 minutes. As experience in learning increased, time required to create the operating space and position the robotic arm decreased significantly. Not creating an island of skin also saves a great deal of surgical time. Average total blood loss was 37.5±6.45 mL and 26.25±7.5 mL. No cases of nipple-areolar complex necrosis or perioperative complications or no local recurrences were reported. There were no local recurrences or deaths that occurred during a mean follow-up period of 3±1 months., Conclusions: All the patients expressed satisfaction with the aesthetic outcome following surgery. There were no significant differences between two groups. This surgical method shows promise for future promotion in the field.

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Objective: To investigate the benefits and drawbacks of breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer and treatment experience of postoperative operation-related complications., Methods: A retrospective analysis was performed on clinical data of 26 female patients with breast cancer who met the selection criteria between September 2021 and March 2023 aging 48.7 years (range, 26-69 years). All tumors were unilateral, with 17 on the left side and 9 on the right side. The tumor size ranged from 1.0 to 7.0 cm, with an average of 2.7 cm. The pathological staging included T 1 in 11 cases, T 2 in 14 cases, and T 3 in 1 case; N 0 in 10 cases, N 1 in 11 cases, N 2 in 2 cases, and N 3 in 3 cases; no distant metastasis (M 0 ) occurred when first diagnosed. Among them, 10 cases underwent breast conserving surgery, and 16 cases underwent nipple-sparing mastectomy. All patients underwent breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap. The operation time, incision length, and postoperative drainage volume in 3 days were recorded. Breast-Q "Satisfaction with back" scale was conducted to evaluate patients' satisfaction with back at 6 months after operation., Results: The operation time was 280-480 minutes (mean, 376.7 minutes), the incision length was 10-15 cm (mean, 12.2 cm), the postoperative drainage volume in 3 days was 500-1 600 mL (mean, 930.2 mL). There were 4 cases of postoperative seroma, 1 case of incision rupture, 1 case of paresthesia of the thoracic wall, and 1 case of edema of the ipsilateral upper limb. All patients were followed up 12-30 months (mean, 20.1 months). No latissimus dorsi muscle flap necrosis, latissimus dorsi muscle atrophy, or shoulder joint dysfunction occurred during follow-up; 2 patients had recurrence of lymph nodes in the ipsilateral axilla after operation, but no distant metastasis occurred. Breast-Q score at 6 months after operation was 64-100 (mean, 79.5). The average score was 78.6 (range, 64-100) in patients underwent nipple-sparing mastectomy and 81.0 (range, 78-100) in patients underwent breast conserving surgery., Conclusion: Breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer is proven to be a surgical approach with safety and cosmetic effects with mild postoperative operation-related complications and considerable patient satisfaction.

Multi-tissue injuries to the foot are common in the pediatric population. Microsurgical repairs are part of the therapeutic arsenal in pediatric reconstructive surgery. We report the case of a 4-year-old boy involved in a lawnmower accident resulting in complete amputation of the hallux, soft tissue damage, and exposure of the calcaneus and first metatarsal. A combined free flap repair using muscle-sparing latissimus dorsi and serratus anterior was performed. The patient was reviewed at 3 months and 1 year with radio-clinical and podoscopic examination. Weight bearing on the foot and on the flap was completely restored without skin fragility. Aesthetics were assessed using a numerical scale and foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Score (FAOS) scores. The results of these scores were good, with a clear improvement at 1 year. Repair of the traumatic foot in children requires a robust surgical strategy to restore function and aesthetics to this complex organ. Our combined free flap of muscle-sparing latissimus dorsi and serratus anterioris are the only ones described in the literature. It appears to be a reliable treatment option, with no morbidity and good functional results., Competing Interests: The authors declare no competing interests., (Copyright: Thomas Albert et al.)

Introduction: Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy., Materials and Methods: This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3)., Results: A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0., Conclusion: Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants., Competing Interests: Disclosure Dr. AMM serves as a consultant/board member for Establishment Labs, Holdings, Inc., but did not receive any financial support or assistance in the preparation of this article. The other co-authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To investigate the feasibility and effect of free latissimus dorsi myocutaneous flap in the reconstruction of giant head and neck defects., Methods: Free latissimus dorsi myocutaneous flap on the cadaver was simulated dissected, and measured by Image-Pro Plus 6.0 to assess the feasibility of repairing giant head and neck defects. Between May 2011 and September 2022, seven patients with giant head and neck defects of different causes repaired with the latissimus dorsi myocutaneous flap were retrospectively analyzed., Results: The diameter of the initiating thoracodorsal artery was (4.03±0.56) mm, and the mean lengths of the arteriolar and venous pedicles of the latissimus dorsi myocutaneous flaps obtained from human specimens were (85.5±10.5) mm and (104±4.2) mm, respectively. Among 7 patients, 5 cases had scalp defects, the remaining 2 cases had neck defects. There were no substantial postoperative problems in the donor site, and all seven latissimus dorsi myocutaneous flaps were successfully transplanted., Conclusions: For the treatment of considerable head and neck deformities, the latissimus dorsi myocutaneous flap is an optimal muscle flap due to its abundance of tissue, enough length of vascular pedicles, and sufficient venous drainage.

Background: Middle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs., Methods: Eight fresh frozen cadaveric shoulders were tested in 3 conditions: (1) intact rotator cuff, (2) IISTT, and (3) MTT transfer using Achilles allograft for IISTTs. Total humeral rotational range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60°, and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed effects model and Tukey post hoc test were used for statistical analysis., Results: Total ROM was significantly increased after IISTT at 20° abduction (P = .037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P > .625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P < .001), 40° abduction-30° ER (P = .016), and 40° abduction-60° ER (P = .002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTT condition (P < .026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction-30° ER compared to the IISTT condition (P < .001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction-30° ER (P < .001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction-60° ER (P < .001). MTT transfer at 20° abduction-30° ER with 24 N loading significantly decreased contact pressure by 91.2 kPa (P = .035)., Conclusions: The MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: About 30% to 50% of women with breast cancer undergo mastectomy, and approximately 50% of them will receive adjuvant radiotherapy (ART). This study evaluates the medium- and long-term impact of ART after immediate breast reconstruction (IBR) with latissimus dorsi myocutaneous (LDM) flap and silicone implants., Methods: Clinical, surgical, and oncological data were retrospectively collected and analyzed based on the medical records of 176 patients who had undergone IBR with LDM flap and silicone implants., Results: The data showed that 7.4% of patients had a history of previous radiotherapy, 56.3% received ART, 31.8% developed capsular contracture with a mean follow-up of 58.1 months, and 14.2% of surgeries were categorized as procedures with a prolonged operating time, lasting above 1 SD of the observed mean. Those who experienced prolonged operating time (odds ratio, 4.72; 95% confidence interval, 1.72-12.93; P = 0.003) and those who received ART (odds ratio, 7.38; 95% confidence interval, 3.18-17.10; P < 0.001) were more likely to develop capsular contracture. Thirty-two patients (18%) underwent capsulectomy with implant replacement, and 7 patients (4%) had the implant removed. The mean time between IBR and reoperation was 29.1 months. Patients who received ART were 2.84 times more likely to experience reconstruction failure or undergo implant-related reoperation ( P = 0.002)., Conclusions: The results indicated that IBR with LDM flap and silicone implant followed by ART is a safe procedure, resulting in low rates of reconstruction failure. However, ART increased the likelihood of capsular contracture development and implant-related reoperation, having a negative effect on reconstructed breasts., Competing Interests: Conflicts of interest and sources of funding: A.M.M. serves as a consultant/board member for Establishment Labs Holdings, Inc, but did not receive any financial support or assistance in the preparation of this article. The other co-authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications., Objective: We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection., Patients and Methods: Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction., Results: In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1-5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm 2 with an average size of 73 cm 2 . The mean follow-up period for these patients was approximately 63.80 months CONCLUSION: The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Breast reconstruction using endoscopically assisted latissimus dorsi (LD) flap leaves no scar on the back; however, the small amount of tissue obtained makes this procedure less practical. This study aimed to propose a new technique of endoscopically assisted extended LD (eeLD) flap plus lipofilling, which could secure a large breast volume., Methods: Lateral thoracic adipose tissues supplied by the thoracodorsal artery branches and the LD muscle were elevated as a single unit only through the mastectomy scar and three ports through the lateral chest. Furthermore, fat was simultaneously injected to support the volume and shape of the breast. Changes in the volume of the reconstructed breast over time were measured using three-dimensional stereophotogrammetry., Results: Overall, 15 breasts of 14 patients who underwent breast reconstruction using an eeLD flap exhibited no serious complications. On average, 281.9 ± 32.4 g of flap and 74.7 ± 19.4 mL of lipofilling were used. Within 8 weeks after the procedure, the volume of the reconstructed breast decreased to 69.5 ± 7.5% and then plateaued. Seven patients needed a subsequent session of lipofilling to acquire adequate breast volume and projection. Notably, according to the BREAST-Q back scores, patients who underwent eeLD flap surgery were significantly more satisfied than those who underwent conventional LD musculocutaneous flap surgery using a skin paddle on the back at the same institution (82.8 ± 9.2 versus 62.6 ± 6.3; P < 0.0001)., Conclusion: Despite the limitations in volume, eeLD flap plus lipofilling is advantageous because it does not leave a noticeable donor-site scar., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

Background: Arthroscopically assisted lower trapezius tendon (aLTT) transfer is one of the treatment options for posterior-superior irreparable rotator cuff tears (PSIRCTs). Although short-term clinical outcomes have shown promising results, there are currently no reported clinical outcomes over a longer follow-up period. This study evaluated the mid-term outcomes of aLTT transfer in patients with a diagnosis of PSIRCT., Methods: This retrospective case-series study included patients who underwent aLTT transfer between May 2017 and May 2019. The clinical outcome assessment included the visual analog scale (VAS) pain score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, Activities of Daily Living Requiring Active External Rotation (ADLER) score, active range of motion, Single Assessment Numeric Evaluation score, and return-to-work rate. The radiographic analysis included the acromiohumeral distance, Hamada grade, and integrity of the transferred tendon at final follow-up. Subgroup analyses were performed based on the integrity of the transferred tendon and the trophicity of the teres minor (Tm)., Results: This study enrolled 36 patients with a mean age of 63.4 years who met the inclusion criteria and were followed up for a mean of 58.2 ± 5.3 months. At final follow-up, the patients showed significant improvement in mean VAS score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, ADLER score, and active range of motion in all directions except internal rotation. A decrease in the acromiohumeral distance and an increase in the Hamada grade were observed at final follow-up (P = .040 and P = .006, respectively). Retears of the transferred tendon occurred in 7 patients, and postoperative infections developed in 2 individuals. An interesting finding was that the retear group still demonstrated improvement in the VAS score but did not show improvement in external rotation at the side by the final follow-up. Compared with the Tm non-hypertrophy group, the Tm hypertrophy group showed significantly better improvement in external rotation at 90° of abduction and at the side, as well as the ADLER score. Of the study patients, 30 (83.3%) were able to successfully resume their previous work., Conclusion: In this study, aLTT transfer in patients with PSIRCTs demonstrated significant improvements in clinical and radiologic outcomes by the final follow-up. These findings provide support for the mid-term safety and effectiveness of aLTT transfer as a viable joint-preserving treatment option for PSIRCTs. However, larger and longer-term studies are still needed to further validate these findings., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

An overall complication rates for implant-based breast reconstruction (IBBR) have been reported from 29 to 46%, particularly in the setting of adjuvant radiotherapy. Although the majority of the literature describes autologous conversion in such scenario, a microsurgical flap is not always feasible. The aim of the paper is to assess surgical and patient-reported outcomes of breast reconstruction using a Latissimus Dorsi muscle Flap (LDMF), harvested without a back scar, in combination with a tissue expander for a two-staged reconstruction in the setting of a previously failed IBBR. All consecutive patients undergoing a two-stages LDMF IBBR between January 2016 and June 2020 were retrospectively identified. A minimal length vertical incision along the posterior axillary line was used for LD flap harvest. Demographic, clinical and surgical data were collected. Aesthetic outcome was evaluated with the Aesthetic Item Scale, and BREAST-Q was used to assess patients' reported outcomes. Twenty-one patients met the inclusion criteria. Mean age was 45.6 years, and the average follow-up was 41.2 months after tissue expander replacement with definitive implant. All patients completed the secondary reconstructive procedure, without major complications both at reconstructive and donor flap site. All women reported to be very satisfied with the final breast reconstruction. Second-attempt implant-based breast reconstruction for patients with a previously failed IBBR is challenging. A conversion from prosthetic to a mixed breast reconstruction with a "no-back scar" LD flap and tissue expander can be considered as a valuable strategy, especially when an abdominal-based autologous breast reconstruction is not feasible or refused by the patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Breast reconstruction is an integral part of breast cancer management. Conventional techniques of flap harvesting for autologous breast reconstruction are associated with considerable complications. Robotic surgery has enabled a new spectrum of minimally invasive breast surgeries. The current systematic review and meta-analysis study was designed to retrieve the surgical and clinical outcomes of robotic versus conventional techniques for autologous breast reconstruction. An extensive systematic literature review was performed from inception to 25 April 2023. All clinical studies comparing the outcomes of robotic and conventional autologous breast reconstruction were included for meta-analysis. The present meta-analysis included seven articles consisting of 783 patients. Of them, 263 patients received robotic breast reconstruction, while 520 patients received conventional technique. Of note, 477 patients received latissimus dorsi flap (LDF) and 306 were subjected to deep inferior epigastric artery perforator (DIEP) flap. There was a significantly prolonged duration of surgery (MD 58.36;95% CI 32.05,84.67;P < 0.001) and duration of anaesthesia (MD 47;95% CI 16.23,77.77;P = 0.003) among patients who underwent robotic surgery. There was a similar risk of complications between robotic and conventional surgeries. The mean level of pain intensity was significantly lower among patients who received robotic breast surgery (MD- 0.28;95% CI - 0.73,0.17; P = 0.22). There was prolonged length of hospitalization among patients with conventional DIEP flap surgery (MD- 0.59;95% CI - 1.13,- 0.05;P = 0.03). The present meta-analysis highlighted the feasibility, safety, and effectiveness of robotic autologous breast reconstruction. This included the successful harvesting of LDF and DIEP flap with acceptable surgical and functional outcomes., (© 2024. The Author(s).)

Background: Recent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction., Method: The study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types., Results: A total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost-to-charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice., Conclusion: The study's results appear to contradict the prevailing notion that TRAM flaps are more cost-effective than DIEP flaps. The total hospital charges to costs using cost-to-charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction., (© 2024 Wiley Periodicals LLC.)

Introduction: Microsurgical breast reconstruction has become popular over the past twenty years and allows a tailor-tuck approach to each patient. However, smoking or coagulation disorders may switch surgeon's choice towards alternative options. When facing these risk factors, we performed pedicled latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap reconstruction with immediate fat transfer (LIFT and TIFT), achieving satisfactory surgical outcomes. Hence, we aim to present our seven-years case-series and discuss our decisional algorithm., Materials and Methods: Thirty smoker women and seven women affected by coagulation disorder (n = 37) respectively had LIFT and TIFT surgery and were retrospectively evaluated. Patients' demographics and outcomes were recorded and compared., Results: LIFT patients received higher volumes of immediate fat grafting compared to TIFT patients (p < 0.05), which required additional lipofilling to provide adequate volume amount, since the TDAP flap was not immediately grafted. However, the additional lipofilling procedures and fat volume were similar (p > 0.05). Flap survival reached 100%, and flap necrosis or loss did not occur. Few minor complications were evidenced in the LIFT group only (p > 0.05)., Conclusion: Based on our experience, we support the reliability of pedicled LD and TDAP flaps with immediate fat transfer in breast reconstruction as valuable alternative to microsurgery in smokers (LIFT) and patients with coagulation disorders (TIFT). However, the results of our study are not conclusive since still must be clarified the role of the smoking and coagulation disorders in microsurgery and the real benefit of a non-microsurgical procedure., Level of Evidence Iv: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Reconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction process. A procedure that has gained interest of the patients is reconstruction of breast using the autologous form. Main objective of this study is to determine the outcomes of modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction., Methodology: This is a retrospective case series which was conducted at the Department of Plastic Surgery, SIMS/Services Hospital, Lahore, from January 2020 till December 2022. 184 patients age 25-60 years and Females with a history of mastectomy, who had to undergo creation of breast shape using a tissue flap from another part of the body at the site of breast following mastectomy were included. All patients were subjected to standard procedure of breast reconstruction with latissimus dorsi flap using modified fleur-de-lis technique and postoperatively weekly assessment in the first month and then monthly until 3 months was carried out and outcome of the study was analysed., Results: The mean age and VAS score of the patients was 49.7 ± 9.17 and 6 ± 2.21, respectively. 57.1 % patients have DCIS, benign in 38 % patients and other tumours were present in 4.9 % patients. Immediate versus delayed reconstruction was done in 63.6 % versus 36.4 % patients respectively. Good aesthetic outcome was achieved in 80.3 % patients CONCLUSION: Modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction yielded a good aesthetic outcome in the majority of the patients., Competing Interests: Declaration of competing interest No., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Reconstructive surgery's workhorse, the latissimus dorsi flap is increasingly abandoned in favour of fasciocutaneous flaps. The purpose of this study was to analyse the methods used to perform this flap and the evolution of its indications in order to define its current place in traumatology. Forty-four cases were recorded retrospectively from January 2000 to December 2020 at HIA Percy, including 37 cases of free flaps, mainly performed for reconstruction of extensive loss of substance with bone and/or joint exposure. It was also performed in 10.8% of cases for salvage after failure of an alternative reconstruction solution. This analysis confirms the value of the latissimus dorsi flap in cases of significant substance loss in the lower limb, but also in burn patients for functional rehabilitation or to allow early rehabilitation., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures., Purpose: To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region., Study Design: Controlled laboratory study., Methods: Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft., Results: Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction ( P = .042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction ( P < .037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles ( P < .039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition ( P < .014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction ( P = .019 and P = .048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles ( P < .023), whereas LTT did not increase the contact area., Conclusion: SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT., Clinical Relevance: These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was provided by Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

&lt;b&gt;Introduction:&lt;/b&gt; Breast cancer is the most frequent cancer among women. Nowadays, more and more women decide to undergo breast reconstruction using both implants and autologous flaps. The most important factor in avoiding bad wound healing is the preservation of blood supply and good tissue perfusion. Latissimus dorsi (LD) flap reconstruction is a commonly used method, mainly reserved for irradiated patients, delayed reconstructions, or salvage procedures. With damaged tissues, objectively assessing the conditions is much more difficult than in primary surgery.&lt;b&gt;Aim:&lt;/b&gt; The aim of the study is to present the intraoperative application of indocyanine green (ICG), in breast reconstructive surgery with a LD flap, as a preventive factor for tissue ischemia and postoperative complications.&lt;b&gt;Materials and methods:&lt;/b&gt; A single-center retrospective review of the outcomes of 12 patients who underwent breast reconstruction using an LD flap, with an intraoperative assessment of flap blood supply using ICG. Patient characteristics, comorbidities, and smoking habit were taken into account.&lt;b&gt;Results:&lt;/b&gt; In two cases, after an initial assessment of tissue perfusion, it was decided to resect the distal part of the flap with less blood supply. All reconstructions were successful and the wounds healed properly. None of the patients required reoperation and there were no postoperative complications or surgical site infections.&lt;b&gt;Conclusions:&lt;/b&gt; The use of ICG in breast reconstruction with an LD flap is an important predictor of postoperative complications, especially flap necrosis and loss of reconstruction.

Background: The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, the authors aim to present clinical and patient-reported outcomes after LDRF reconstruction., Methods: An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoracodorsal and intercostal systems. An institutional review board-approved retrospective review of 10 patients who underwent LDRF with one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurologic status, and functional status were evaluated using validated surveys. One-way analysis of variance and post hoc Tukey tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t tests., Results: The tenth rib (4.65 ± 2.01) followed by the ninth rib (3.7 ± 1.63) had the highest number of perforators. A combination of the ninth and eleventh ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both preoperative and postoperative questionnaires; Median clinical follow-up was 48 months (range, 34 to 70 months). Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale ( P = 0.22), the Functional Independence Measure (Motor, P = 0.52; Cognitive, P = 0.55), or the Headache Disability Index ( P = 0.38). The minimum clinically important difference was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test., Conclusion: The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety., Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation., Results: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I 2  = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I 2  = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I 2  = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I 2  = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I 2  = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I 2  = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I 2  = 0%)., Conclusions: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Having established itself in various other areas of surgery as well as in urology, robotics is increasingly gaining importance in plastic surgery. The case presented in this manuscript describes the first published robotic-assisted harvesting of a latissimus dorsi muscle free flap in the German-speaking world. The aim is to increase the knowledge of robotics in plastic surgery and to support the introduction of robotic-assisted plastic surgery in Germany., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The fat-augmented latissimus dorsi (FALD) flap is an evolution of the traditional latissimus dorsi (LD) flap, which allows to obtain a total autologous breast reconstruction (BR) avoiding the use of breast implants. The aim of this study was to develop a predictive preoperative formula in order to estimate and optimize the amount of fat to be transferred during FALD flap BR, using only anthropometric measurements., Methods: We conducted a prospective clinical study between September 2020 and April 2023. All patients underwent back pre-operative ultrasound scan to assess the subcutaneous skin paddle thickness (SPT) and a regression analysis was performed to evaluate which anthropometric variable had a better correlation with this thickness., Results: Data from 66 FALD flaps were collected. The mean SPT was 11.95 mm (SD 4.56). A significant correlation between SPT and body mass index (BMI) was found (r = 0.640, p < 0.0001). Using the fat-to-capacity ratio (113%), the following formula (the FALD-V) was developed to predict the needed fat transfer into FALD flap: [-509 + 12.32 × BMI + 11.71 × skin paddle width + 17.43 × skin paddle height] × 1.13. The considered variables (BMI, skin paddle width and skin paddle height) were statistically significant (p < 0.001, p = 0.0483, p = 0.0154, respectively). The cross-validation confirmed the accuracy of the formula (r = 0.810)., Conclusion: The FALD-V can be used as an innovative complimentary device in the planning of FALD flap one-stage total autologous BR. To enhance its application, a 3.0 WebApp at www.braflap.com (and www.breast-v.com) is available free of charge for both iOS and Android devices., Level of Evidence: II., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To analyze the clinical outcomes of lower trapezius transfer (LTT) for patients with functionally irreparable rotator cuff tears (FIRCT) and summarize the available literature regarding complications and reoperations., Methods: After registration in the International prospective register of systematic reviews (PROSPERO [CRD42022359277]), a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Inclusion criteria were English, full-length, peer-reviewed publications with a level of evidence IV or higher reporting on clinical outcomes of LTT for FIRCT. Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus via Elsevier databases were searched. Clinical data, complications and revisions were systematically recorded., Results: Seven studies with 159 patients were identified. The mean age range was 52 to 63 years, 70.4% of the patients included were male, and the mean follow-up time ranged between 14 and 47 months. At final follow-up, LTT lead to improvements in range of motion, with reported forward elevation (FE) and external rotation (ER) mean gains of 10° to 66° and 11° to 63°, respectively. ER lag was present before surgery in 78 patients and was reversed after LTT in all shoulders. Patient-reported outcomes were improved at final follow-up, including the American Shoulder and Elbow Society score, Shoulder Subjective Value and Visual Analogue Scale. The overall complication rate was 17.6%, and the most reported complication was posterior harvest site seroma/hematoma (6.3%). The most common reoperation was conversion to reverse shoulder arthroplasty (5%) with an overall reoperation rate of 7.5%., Conclusions: Lower trapezius transfer improves clinical outcomes in patients with irreparable rotator cuff tears with a rate of complications and reoperations comparable to other surgical alternatives in this group of patients. Increases in forward flexion and ER are to be expected, as well as a reversal of ER lag sign when present before surgery., Level of Evidence: Level IV, systematic review of Level III-IV studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: The use of pedicled dorsal flaps sparing the latissimus dorsi muscle (TDAP and MSLD flap) is a well-described reconstruction method in breast reconstruction after breast cancer. However, little data exists regarding patient satisfaction after this surgery. The main objective of this study was to evaluate patient satisfaction after unilateral total secondary breast reconstruction using a TDAP or MSLD flap. The secondary objectives corresponded to the evaluation of postoperative complications following this surgery, the evaluation of the duration of the reconstruction and the nature of additional interventions, the evaluation of the functional after-effects, and the evaluation of the chest size when the reconstruction is completed., Material and Method: This is a monocentric, retrospective cohort study, including 22 patients who underwent unilateral secondary total breast reconstruction using a TDAP or MSLD flap between January 1, 2018 and December 31, 2022. Patient satisfaction was assessed using three questionnaires validated in breast reconstruction: the Reconstruction module of the BREAST-Q, the MBROS-S and the MBROS-BI., Results: The MBROS-S satisfaction score is 71.4%. The MBROS-BI body image score is 62%. With the BREAST-Q, the Satisfaction with Breast score is estimated at 53.1; the Satisfaction with Back score is estimated at 75.5; the physical well-being score regarding the chest is evaluated at 71.7; the physical well-being score concerning the shoulder and back is evaluated at 67.4; the psychosocial well-being score is assessed at 67.4; the sexual well-being score is estimated at 48.7; and for women who have benefited from reconstruction associated with a prosthesis, the satisfaction score regarding the implant is 71.6., Conclusion: Unilateral total secondary breast reconstruction with a dorsal pedicled flap sparing the latissimus dorsi muscle is an elegant, reliable, and respectful way to reconstruct a breast, and appears to give high levels of satisfaction., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Chronic fistulas are a dreaded complication to surgery. They are often persistent to treatment and involve several negative side effects and a significant reduction in quality of life. We present a case report of a 36-year-old male with a deep chronic fistula in the pelvis after pouch surgery. More than 60 procedures were performed under general anaesthesia without treatment effect. Through a multidisciplinary approach a complete rectum extirpation and reconstruction with a free latissimus dorsi flap was performed. The patient was seen at followup 18 months after the surgery; pain free and without relapse., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Background: Few studies have reported the outcomes of LDF and immediate fat transfer (LIFT) during breast reconstruction. The aim of this study was to compare the perioperative outcomes and complications of LIFT and standard LDF (without immediate fat transfer) for breast reconstruction., Methods: We retrospectively reviewed charts from patients undergoing autologous breast reconstruction after total mastectomy between 2011 and 2021. We compared intraoperative and postoperative outcomes between groups., Results: One hundred nineteen reconstructions (61.02%) were performed with LIFT, while seventy-six (38.98%) were performed with standard LDF. The median volume of total fat transferred during LIFT was 125-cc [110-170 ​cc]. The rates of donor site wound disruption (23.7% versus 12.6%, p ​= ​0.044) were higher using the standard LDF compared to LIFT. Reconstructions performed with LIFT (HR 4.01, p ​< ​0.001) were found to be associated with secondary fat grafting procedures., Conclusion: LIFT is a safe procedure to enhance the volume of LDF in patients desiring autologous reconstruction without increasing recipient-site morbidity. On a time-to-event analysis, LIFT was associated with the requirement of further revision procedures using secondary fat grafting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q © scale., Methods: In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted., Results: Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved. This is the first study to compare the differences in results according to the flap design method during breast reconstruction. Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed. In addition to breast shape, donor scars and complications were also investigated., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)