The architectural design of a muscle is one of the most accurate predictors of muscle function however, detailed architectural data on the latissimus dorsi muscle are limited. There is some dispute regarding the potential contribution of this muscle to lumbar spine function. The latissimus dorsi is primarily considered a muscle with actions at the shoulder, despite its widespread attachments at the spine. In addition, theseĪrchitectural analysis and predicted functional capability of the human latissimus dorsi muscle These data provide novel insights into the ability of the latissimus dorsi muscle to generate force and change length throughout the spine and shoulder ranges of motion. Across shoulder range of motion, latissimus dorsi acts primarily on the plateau region and descending limbs of the force length curve during both flexion/extension and abduction/adduction. Across spine range of motion, biomechanical modelling predicted latissimus dorsi acts across both the ascending and descending limbs of the force-length curve during lateral bend, and primarily at or near the plateau region (where maximum force generation is possible) during flexion/extension and axial twist. Measured sarcomere length in the post-mortem neutral spine posture was nearly optimal at 2.69Â☐.06 μm. The physiological cross-sectional area of latissimus dorsi was 5.6Â☐.5 cm2 and normalized fascicle length was 26.4Â☑.0 cm, indicating that this muscle is designed to produce a moderate amount of force over a large range of lengths. From these data, sarcomere length operating ranges were modelled to determine the force-length characteristics of latissimus dorsi across the spine and shoulder ranges of motion. One latissimus dorsi muscle was removed from each of 12 human cadavers, separated into regions, and micro-dissected for quantification of fascicle length, sarcomere length, and physiological cross-sectional area. Therefore, the aim of this study was to quantify the architectural properties of the latissimus dorsi muscle and model mechanical function in light of these new data. Pectoralis and latissimus dorsi muscles were shown as reliable and safe recipients for fat grafting.Īrchitectural analysis and predicted functional capability of the human latissimus dorsi muscle. Immediate fat transfer into the pectoralis and latissimus dorsi muscle increases the breast volume during the reconstruction with extended latissimus dorsi flap avoiding implant-related complications when abdominal tissue is not available. Incidence and the size of oil cysts and fat necroses were significantly lower in muscular layer in comparison with the subcutaneous layer of the reconstructed breast. Results of postoperative ultrasound examination were evaluated. The most common complication was donor site seroma, which occurred in 57.1%. All flaps healed uneventfully and no fat grafting-related complications were observed. Mean injected fat volume was 86.4 ml (range, 50 to 160 ml) and majority of this volume was injected into the pectoralis muscle. Mean patient age was 48.2 years (range, 34 to 64 years). Fat injected into the pectoralis muscle formed an apparent bulging - autoprosthesis.
Fat was injected under visual control between muscle fibers. From 2013 to 2016, 14 patients underwent secondary unilateral total breast reconstruction with extended latissimus dorsi flap associated with primary fat grafting into the pectoralis major and latissimus dorsi muscles.
The authors present their experience with the use of extended latissimus dorsi flap associated with immediate fat grafting into the pectoralis and latissimus dorsi muscles for secondary breast reconstruction. Its disadvantage is the limited volume of transferred tissue. The latissimus dorsi flap is a reliable and one of the most commonly used methods of both immediate and delayed breast reconstruction.
Streit, L Dražan, L Schneiderová, M Kubek, T Sin, P Veselý, K Coufal, O Veselý, J INTRAOPERATIVE FAT GRAFTING INTO THE PECTORALIS AND LATISSIMUS DORSI MUSCLES-NOVEL MODIFICATION OF AUTOLOGOUS BREAST RECONSTRUCTION WITH EXTENDED LATISSIMUS DORSI FLAP.
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