Dermatofibrosarcoma protuberans de mama con reconstrucción con colgajo del dorsal ancho. Reporte de caso

El Dermatofibrosarcoma Protuberans es un tumor cutáneo fibrohistiocítico, extremadamente raro y representa menos del 1% de los tumores mamarios. Se caracteriza por un lento crecimiento, pero con comportamiento infiltrante con altas tasas de recidiva local. Se puede sospechar clínicamente, la confirmación es histopatológica y se debe complementar con inmunohistoquímica. El tratamiento de elección es quirúrgico. Se presenta el caso de una mujer de 23 años con Dermatofibrosarcoma Protuberans de mama derecha, sometida a tumorectomía y reconstrucción inmediata de colgajo de dorsal ancho. La paciente tuvo evolución satisfactoria, sin evidencia de enfermedad.

SUMMARY Dermatofibrosarcoma protuberans is a fibro histiocytic cutaneous tumor extremely rare that accounts for less than 1% of all breast cancers, and it is characterized by slow growing but locally invasiveness with high recurrence rates. Confirmation of the diagnosis is with histopathology with immunohistochemistry. Treatment of choice is surgical resection with latissimus dorsalis reconstruction. We present the case of a 23-year-old woman with dermatofibrosarcoma protuberans of the right breast in whom a tumorectomy followed by latissimus dorsalis reconstruction was performed. The patient had a favorable clinical evolution remaining free of disease.

Debridement of axillary necrotizing fasciitis under anesthetic blocks of the serratus plane and supraclavicular brachial plexus: a case report

Abstract The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was accomplished under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and with venous sedation. We observed satisfactory anesthesia 15 minutes after the intervention, efficient intraoperative pain control and within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.

The incidence and risk factors of lumbodorsal fasciitis in osteoporotic vertebral compression fractures / 中华骨科杂志

Objective:To identify the incidence and risk factors related to lumbodorsal fasciitis in acute osteoporotic vertebral compression fractures (OVCF).Methods:The clinical data of 1182 acute OVCF hospitalized in Zhongda Hospital Southeast University between June 2016 and October 2020 were retrospectively analyzed, including 219 males and 963 females, aged 72.19±9.39 years (range, 45-98 years). The demographics, comorbidity profile, spine trauma, back pain duration, and vertebral fracture number of the OVCF with or without lumbodorsal fasciitis were summarized and compared. The independent risk factors of lumbodorsal fasciitis were identified by binary logistic regression analysis.Results:There were 532 cases of OVCF complicated with lumbodorsal fasciitis among 1,182 patients, and the incidence was 45.01%. The OVCF with fasciitis had higher ratio of males (23.5%, 125/532) than the OVCF without (14.5%, 94/650) fasciitis (χ 2=15.82, P<0.001). The OVCF with fasciitis were aged 74.57±9.21 years and significantly older than the OVCF (aged 70.24±9.60 years) without fasciitis ( t=7.85, P<0.001). The highest proportion of patients with OVCF combined with fasciitis was ≥80 years old (36.1%, 192/532), while most (34.6%, 225/650) of the OVCF without fasciitis were aged 60-70 years (χ 2=56.27, P<0.001). The OVCF with fasciitis had higher ratio of no evident spine trauma (37.0%, 197/532) and multiple vertebral fractures involving ≥3 vertebra (10.5%, 56/532) than the OVCF without fasciitis [26.3% (171/650), 3.2% (21/650); χ 2=17.67, P<0.001; χ 2=40.63, P<0.001]. The ratio of pre-hospital back pain >4 weeks was higher in the OVCF with (20.7%, 110/532) than without (7.4%, 48/650) fasciitis (χ 2=62.46, P<0.001). The OVCF with fasciitis had higher comorbidity of hypertension (52.8%, 281/532), coronary heart disease (14.7%, 78/532), and cerebral infarction (24.8%, 132/532) than the OVCF without fasciitis [42.8% (278/650), 9.9% (64/650), 17.9% (116/650); χ 2=11.85, P<0.001; χ 2=6.42, P=0.011; χ 2=8.56, P=0.003]. The OVCF with fasciitis had higher ratio of two comorbidities (23.7%, 126/532) than the OVCF without fasciitis (16.1%, 105/650) (χ 2=21.15, P<0.001). Binary logistic regression analysis showed significantly higher risk of lumbodorsal fasciitis in males than in females ( OR=1.69, P=0.001), in age group 60-<70、70-<80 and ≥80 years than in <60 years ( OR=2.28, P=0.002; OR=2.64, P<0.001; OR=4.90, P<0.001), in back pain for 2-<4 weeks and >4 weeks than in ≤1 week ( OR=1.70, P=0.005; OR=3.81, P<0.001), and in multiple fractures involving 2 and ≥3 vertebra than in single vertebrae ( OR=1.75, P=0.003; OR=3.36, P<0.001). Conclusion:Up to 45% of acute OVCF have concurrent lumbodorsal fasciitis. Male, aged ≥60 years, pre-hospital back pain ≥2 weeks, and fractures in ≥2 vertebra are independent risk factors of lumbodorsal fasciitis in OVCF.

Presence of incomplete superficial axillary arch and pectoralis quartus muscle in one male body / Presencia en un individuo de un arco axilar superficial incompleto y de un músculo pectoral cuarto

SUMMARY: The anatomical variations of the pectoralis major muscle (PMM) and latissimus dorsi muscle (LDM) range from agenesis to the presence of supernumerary fascicles with a variety of insertions and relationships with the muscles, fascia, vessels, nerves and skeletal components of the shoulder girdle and the axilla. Many of these variations are clinically irrelevant, but extremely interesting and revealing from the perspective of comparative anatomy, ontogeny, and phylogeny. In this report, we present two different supernumerary muscles in the chest of one adult male body, identified during dissection practice of undergraduate medical students at Universidad Surcolombiana. These supernumerary fascicles in the axillary region were caudal to the lower edge of the PMM on the right side of the chest, and in contact with the anterior edge of the LDM on the left side of the chest; each fascicle was inserted in the ipsilateral coracoid process. These observations are congruent with the pectoralis quartus muscle and an incomplete and superficial axillary arch, respectively.

RESUMEN: Las variaciones anatómicas del músculo pectoral mayor (MPM) y del músculo latísimo del dorso (MLD) van desde la agenesia hasta la presencia de fascículos supernumerarios con una variedad de inserciones y relaciones con los músculos, fascias, vasos, nervios y componentes esqueléticos de la cintura escapular y la axila. Clínicamente, muchas de las variaciones son irrelevantes, pero extremadamente interesantes y reveladoras desde la perspectiva de la anatomía comparada, la ontogenia y la filogenia. En este estudio, presentamos dos músculos supernumerarios diferentes en la pared torácica de un hombre adulto, identificados durante la práctica de disección de estudiantes de medicina de la Universidad Surcolombiana. Estos fascículos supernumerarios en la región axilar estaban caudales al margen inferior del MPM en el lado derecho del tórax y en contacto con el margen anterior del MLD en el lado izquierdo del tórax; cada fascículo se insertaba en el proceso coracoides ipsilateral. Estas observaciones son congruentes con el músculo pectoral cuarto y un arco axilar incompleto y superficial, respectivamente.

Microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome / 中国基层医药

Objective:To investigate the clinical efficacy of microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome. Methods:110 patients with lumbar and dorsal myofascial pain syndrome who received treatment between February 2019 and August 2020 in Haining People's Hospital were included in this study. They were randomly assigned to receive either electroacupuncture (control group, n = 55) or microacupotomy combined with Du pulse acupuncture (observation group, n = 55). Therapeutic effects were compared between the control and observation groups. Results:Before treatment, there were no significant differences in tenderness and Visual Analogue Scale scores between the control and observation groups (both P > 0.05). After treatment, tenderness and VAS scores in the observation group were (0.81 ± 0.11) points and (2.36 ± 0.25) points, respectively, which were significantly lower than those in the control group [(1.31 ± 0.10) points, (3.34 ± 0.19) points, t = 24.943 and 23.146, both P < 0.001]. Effective rate in the observation group was significantly higher than that in the control group [98.18% (54/55) vs. 81.82% (45/55), χ2 = 8.182, P < 0.05]. After treatment, tenderness scores of the gluteus medius, psoas quadratus and multifidus muscles in each group were increased, and these scores in the observation group were significantly higher than those in the control group ( t = 3.937, 2.963 and 3.633, all P < 0.05). Conclusion:Microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome can effectively decrease the degree of pain and strengthen clinical therapeutic effects.

Clinical research on lumbar oblique-pulling manipulation in combination with sling exercise therapy for patients with chronic nonspecific low back pain

SUMMARY OBJECTIVE: To investigate clinical curative effects of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training on chronic nonspecific lower back pain. METHODS: A total of 60 patients with chronic nonspecific lower back pain in the Outpatient Department were included in this study. These patients were randomly divided into two groups: the observation group and the control group. The control group adopted a single sling-exercise-therapy training three times a week, while the observation group adopted lumbar oblique-pulling manipulation in combination with manipulation treatment once a week. The course of treatment lasted for four weeks. RESULTS: (1) Before and after treatment, the ODI score was compared within the group. A remarkable statistical significance was observed from the third day (P<0.05). At the third month of follow-up, the difference in ODI scores between these two groups was statistically significant (P<0.05). (2) Before and after treatment, it was observed that differences in VAS scores from the third day were statistically significant (P<0.05). (3) The difference in muscle strength between these two groups had remarkable statistical significance in the third month of follow-up (P<0.05). CONCLUSION: The effective rehabilitation function of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training in patients with CNLBP is superior to that of sling-exercise-therapy training alone.

RESUMO OBJETIVO: Investigar os efeitos curativos da manipulação lombar com o movimento de puxar oblíquo combinado a terapia por exercícios de sling-training para dor lombar baixa crônica não específica. METODOLOGIA: Um total de 60 pacientes com dor lombar baixa crônica não específica no ambulatório foram incluídos neste estudo. Esses pacientes foram divididos aleatoriamente em dois grupos: o grupo de observação e o grupo de controle. O grupo de controle aderiu apenas à terapia por exercícios de sling-training três vezes por semana, enquanto o grupo de observação aderiu à manipulação lombar com o movimento de puxar oblíquo combinado à terapia por exercícios de sling-training uma vez por semana. O tratamento durou quatro semanas. RESULTADOS: (1) Antes e após o tratamento, o escore de ODI foi comparado no grupo. Uma significância estatística notável foi observada a partir do terceiro dia (P<0,05). No terceiro mês de acompanhamento, a diferença nos escores de ODI entre os dois grupos foi estatisticamente significante (P<0,05). (2) Antes e após o tratamento, observou-se que diferenças nos escores de VAS a partir do terceiro dia foram estatisticamente significantes (P< 0,05). (3) A diferença de força muscular entre os dois grupos apresentou significância estatística notável no terceiro mês de acompanhamento (p<0,05). CONCLUSÃO: A função de reabilitação efetiva da manipulação lombar com o movimento de puxar oblíquo combinada à terapia por exercícios de sling-training em pacientes com dor lombar baixa crônica não específica é superior à da terapia por exercícios de sling-training sozinha.

Paraspinal Ancient Schwannoma of the Dorsal Ramus Nerve: A Case Report / 대한척추외과학회지

STUDY DESIGN: Case report. OBJECTIVES: We report a case of paraspinal ancient schwannoma located at the upper thoracic level that mimicked an atypical lipoma or complicated epidermoid cyst. SUMMARY OF LITERATURE REVIEW: Few case reports of paraspinal schwannoma have been reported and the incidence of ancient schwannoma in the paraspinal muscle layer is very rare. MATERIALS AND METHODS: A 39-year-old man complained of a growing palpable back mass for 5 years. He experienced aggravated chronic discomfort around the mass while lying down. Both T1- and T2- weighted magnetic resonance imaging (MRI) showed a well-capsuled and heterogeneous high-signal mass in the muscle layer at the level from the T1 to T4 vertebral bodies on the right side of the midline. The tumor was completely removed by en bloc resection. RESULTS: The pathologic examination revealed S-100 protein expression with degenerative changes. The lesion was diagnosed as an ancient schwannoma. CONCLUSIONS: Schwannoma is one among the multiple possible causes of benign back masses. If a mass reveals a well-encapsulated heterogeneous mass on contrast MRI, a schwannoma should be suspected.

Efficacy of bilateral erector spinae plane block in improving intraoperative wake-up quality in patients undergoing thoracolumbar scoliosis correction with general anesthesia / 中华麻醉学杂志

Objective@#To evaluate the efficacy of bilateral erector spinae plane block (ESPB) in improving intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.@*Methods@#Forty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients of both sexes, aged 18-60 yr, scheduled for elective posterior approach thoracolumbar scoliosis correction, were divided into 2 groups (n=20 each) using a random number table method: control group (C group) and bilateral ESPB group (E group). Bilateral ESPB was performed through injecting 0.375% ropivacaine 15-20 ml to each site in group E. Anesthesia was induced by intravenously injecting propofol, sufentanil and cisatracurium after dexmedetomidine was intravenously infused for 10 min.Anesthesia was maintained by intravenously infusing remifentanil, propofol and dexmedetomidine.Propofol infusion was stopped and the infusion rate of remifentanil and dexmedetomidine was decreased during intraoperative wake-up test.Wake-up test was performed every 30 s starting from 5 min after stopping propofol infusion.The wake-up time, occurrence of agitation and coughing, hemodynamic changes (△MAP and △HR, the difference between MAP while stopping administration before wake-up test and maximum MAP during wake-up test, the difference between HR while stopping administration before wake-up test and maximum HR during wake-up test) and blood loss were recorded.The wake-up quality was assessed during operation.@*Results@#Compared with C group, the wake-up time was significantly shortened, the incidence of agitation and coughing was decreased, blood loss was reduced, △MAP and △HR were decreased, and the wake-up quality was increased in E group (P<0.05).@*Conclusion@#Bilateral ESPB can increase the intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.

Efficacy of bilateral erector spinae plane block in improving intraoperative wake-up quality in patients undergoing thoracolumbar scoliosis correction with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of bilateral erector spinae plane block (ESPB) in improving intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-60 yr,scheduled for elective posterior approach thoracolumbar scoliosis correction,were divided into 2 groups (n=20 each) using a random number table method:control group (C group)and bilateral ESPB group (E group).Bilateral ESPB was performed through injecting 0.375％ ropivacaine 15-20 ml to each site in group E.Anesthesia was induced by intravenously injecting propofol,sufentanil and cisatracufium after dexmedetomidine was intravenously infused for 10 min.Anesthesia was maintained by intravenously infusing remifentanil,propofol and dexmedetomidine.Propofol infusion was stopped and the infusion rate of remifentanil and dexmedetomidine was decreased during intraoperative wake-up test.Wake-up test was performed every 30 s starting from 5 min after stopping propofol infusion.The wake-up time,occurrence of agitation and coughing,hemodynamic changes (△ MAP and △ HR,the difference between MAP while stopping administration before wake-up test and maximum MAP during wake-up test,the difference between HR while stopping administration before wake-up test and maximum HR during wake-up test) and blood loss were recorded.The wake-up quality was assessed during operation.Results Compared with C group,the wake-up time was significantly shortened,the incidence of agitation and coughing was decreased,blood loss was reduced,△ MAP and △ HR were decreased,and the wake-up quality was increased in E group (P＜ 0.05).Conclusion Bilateral ESPB can increase the intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.

Distribution of regions of ultrasound-guided erector spinae plane block at the level of Ts transverse process / 中华麻醉学杂志

Objective To study the distribution of the regions of ultrasound-guided erector spinae plane block (ESPB) at the level of T5 transverse process.Methods Thirty male patients,aged 18-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracotomy,were enrolled in this study.ESPB was conducted with 0.5％ ropivacaine hydrochloride 0.4 ml/kg at the level of T5 transverse process under ultrasound guidance before induction of general anesthesia.Blocks in each thorax and back region (the left side of the body was divided into 18 different regions based on the anatomical "landmarks" on the body surface,No.1-18) were assessed by cold stimulation.Effective block in each region was recorded at 10,15,20,25,30,40 and 50 min after administration.The adverse reactions such as pneumothorax,puncture hematoma and local anesthetic intoxication were recorded.Results The blocking range was basically fixed at 30 min after a single ESPB injection at the level of T5 transverse process,and the regions covered from the sternal angle to the level of the rib arch.The regions of effective block were No.1-3 and 5-7 in ≥95％ patients,and the regions of effective block were No.1-15 and 17 in patients ≥90％ and ＜ 95％.No patients developed adverse reactions such as pneumothorax,puncture hematoma or local anesthetic intoxication.Conclusion The regions of effective ultrasound-guided ESPB at the level of T5 transverse process are mainly distributed in T2-T8 thoracodorsal skin areas.

Volumetric change of the latissimus dorsi muscle after immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap

BACKGROUND: In immediate breast reconstruction using an extended latissimus dorsi musculocutaneous (eLDMC) flap, the volume of the flap decreases, which causes a secondary deformity of the breast shape. Since little research has investigated this decrease in muscle volume, the authors conducted an objective study to characterize the decrease in muscle volume after breast reconstruction using an eLDMC flap. METHODS: Research was conducted from October 2011 to November 2016. The subjects included 23 patients who underwent mastectomy due to breast cancer, received immediate reconstruction using an eLDMC flap without any adjuvant chemotherapy or radiotherapy, and received a computed tomography (CT) scan from days 7 to 10 after surgery and 6 to 8 months postoperatively. In 10 patients, an additional CT scan was conducted 18 months postoperatively. Axial CT scans were utilized to measure the volumetric change of the latissimus dorsi muscle during the follow-up period. RESULTS: In the 23 patients, an average decrease of 54.5% was observed in the latissimus dorsi muscle volume between the images obtained immediately postoperatively and the scans obtained 6 to 8 months after surgery. Ten patients showed an average additional decrease of 11.9% from 6–8 months to 18 months after surgery. CONCLUSIONS: We studied changes in the volume of the latissimus dorsi muscle after surgery using an eLDMC flap performed after a mastectomy without adjuvant chemotherapy or radiotherapy. In this study, we found that immediate breast reconstruction using a latissimus dorsi muscle flap led to a decrease in muscle volume of up to 50%.

Perfil da musculatura extensora lombar de trabalhadores rurais na atividade leiteira / Lumbar extensor muscle profile of rural milk production workers

Introdução: A atividade leiteira é um sistema de trabalho que envolve diversas tarefas, que vão desde o manejo com o gado, alimentação, ordenha, até o consumo do produto final. A dinamometria isométrica de extensão lombar tem sido descrita como um bom instrumento de avaliação e acompanhamento laboral, sobretudo de populações que exercem muita força para desempenhar suas atividades. Objetivo: Avaliar a força isométrica de extensão lombar de produtores rurais na atividade leiteira. Métodos: A amostra contou com 47 trabalhadores rurais que exercem atividade leiteira cadastrados na Empresa de Assistência Técnica e Extensão Rural/Associação Sulina de Crédito e Assistência Rural do Rio Grande do Sul, que foram avaliados por meio de questionário sociodemográfico e testaram a força muscular de extensão lombar por meio de um sistema de dinamometria isométrica. Resultados: Participaram do estudo 20 homens com idade média de 50,45±9,44 anos e 27 mulheres com idade média de 46,15±7,56 anos. Quanto à força isométrica de extensão lombar, o grupo masculino alcançou 1169±289,96 N e o grupo feminino 571,34±190,36 N. Conclusão: Podemos concluir que o perfil da musculatura extensora lombar de trabalhadores rurais na atividade leiteira alcança valores superiores em indivíduos do gênero masculino, o que pode ser atribuído ao fato de homens apresentarem maiores níveis de massa corporal e consequentemente gerarem maior força

Background: Milk production is a work system that comprises several tasks from cattle handling, feeding and milking to product consumption. Isometric lumbar extension dynamometry is considered a satisfactory instrument for occupational evaluation and monitoring, especially for populations of workers whose activities demand high levels of strength. Objective: To investigate isometric lumbar extension strength among rural milk production workers. Methods: The sample comprised 47 rural milk production workers affiliated with the Technical Assistance and Rural Outreach Company/Southern Credit and Rural Assistance Company (Empresa de Assistência Técnica e Extensão Rural/Associação Sulina de Crédito e Assistência Rural ­ EMATER/ASCAR), Rio Grande do Sul, Brazil. The participants were analyzed based on a sociodemographic questionnaire and lumbar extensor muscle strength testing by means of an isometric dynamometry system. Results: Participants were 20 men with average age 50.45±9.44 years old and 27 women with average age 46.15±7.56 years old. The isometric lumbar extension strength was 1,169±289.96 N for the men and 571.34±190.36 N for the women. Conclusion: The lumbar extensor muscle profile of rural milk production workers was characterized by higher values for the men, which might be attributed to the fact that men exhibit higher body mass levels, and consequently produce greater force

Lumbar Extensor Muscle Size and Isometric Muscle Strength in Women with Symptomatic Lumbar Degenerative Diseases

STUDY DESIGN: A cross-sectional design. PURPOSE: To determine the characteristics of lumbar extensor muscle (LEM) size and isometric muscle strength and examine their correlations in women with lumbar degenerative diseases (LDDs). OVERVIEW OF LITERATURE: Many studies have evaluated the relationship between muscle size and strength, but the results have been controversial. METHODS: Seventy-four female patients (mean age, 66 years) who consecutively underwent posterior lumbar interbody fusion (L1–S1) were recruited. The cross-sectional area (CSA) of the back extensor muscles was measured between L1–2 to L5–S1, and the total sum of the CSAs at each disc level was calculated. Back extensor muscle strength was evaluated using a MedX lumbar extension machine. The Oswestry Disability Index (ODI, 0–100) and Visual Analog Scale (VAS, 0–10) of lower back pain were determined. RESULTS: The mean CSAs of the LEM at each level (L1/2–L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. The mean isometric strength at each angle (range, 0°–72°) was 32.5, 50.1, 72.0, 88.7, 100.7, 112.2, and 126.2 ft-lb, respectively. The mean ODI and VAS scores were 54.6 and 6.6, and the mean body weight and body mass index (BMI) were 59.9 kg and 24.9 kg/m2, respectively. The CSAs of the upper lumbar level (L1–4) and the total sum of the CSAs were associated with isometric strength, which was negatively correlated with patients’ age and ODI and positively associated with body weight and BMI, mainly at higher lumbar flexion angles (48°–72°). CONCLUSIONS: In women with LDD, LEM sizes of the upper lumbar levels (L1–4) were larger than those of the lower levels (L4–S1) and were positively associated with muscle strength. The upper lumbar levels in patients with LDDs appear to play a compensatory role when degenerative lesions are present in the lower lumbar levels.

The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction

BACKGROUND: In performing extended latissimus dorsi (ELD) flap procedures, a skin paddle design on the bra line helps reduce visible scarring. This improves the patient’s satisfaction with the outcome. However, such a design leads to a longer operation time and increased fatigue of the surgeon due to the narrow operative field. In this study, the authors propose a method that elongates the axillary incision line posteriorly by 1.5 cm from the lateral border of the latissimus dorsi muscle. We examined whether this method could shorten the operation time and compared the incidence of complications between patients who underwent this novel procedure and patients who underwent the traditional procedure. METHODS: In this study of patients who underwent ELD flap procedures for immediate breast reconstruction, 89 underwent surgery with the elongated axillary incision and 45 underwent surgery without the elongated incision. The total operation time and complications were retrospectively examined based on the patients’ medical records, and we examined whether there was any statistically significant difference in the total operation time. RESULTS: In the experimental group with the elongated axillary incision, the operation time ranged from 125 to 255 minutes (median, 175 minutes). In contrast, in the control group without the elongated axillary incision, the operation time ranged from 142 and 340 minutes (median, 205 minutes). The operation time was statistically significantly different between the two groups, and no significant complications were observed in the experimental group. CONCLUSIONS: Elongation of the axillary incision alone may shorten the operation time of the ELD flap procedure without causing additional complications.

Will a Fibrin Sealant be Effective as a Seroma Reductant and a Hemostatic Agent in Breast Reconstruction Using a Latissimus Dorsi Flap?

BACKGROUND: The latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. METHODS: A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. RESULTS: The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. CONCLUSIONS: The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.

Will a Fibrin Sealant be Effective as a Seroma Reductant and a Hemostatic Agent in Breast Reconstruction Using a Latissimus Dorsi Flap?

BACKGROUND: The latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. METHODS: A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. RESULTS: The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. CONCLUSIONS: The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.

Comparison of morbidity-related seroma formation following conventional latissimus dorsi flap versus muscle-sparing latissimus dorsi flap breast reconstruction

PURPOSE: The pedicled, descending-branch muscle-sparing latissimus dorsi (MSLD) flap has been widely used for breast reconstruction following total mastectomy. However, the superiority of the MSLD flap compared to the conventional latissimus dorsi (CLD) flap in preventing seroma formation has not been demonstrated. This study compares the morbidities related to seroma formation following pedicled MSLD flap and CLD flap breast reconstruction. METHODS: A total of 15 women who underwent partial mastectomy and immediate partial breast reconstruction with MSLD flaps were compared with 15 women under identical conditions with CLD flap breast reconstruction. The medical records were reviewed for both complications and demographic data. The authors compared morbidity, including donor-site seroma, total volume of drain discharge, indwelling period of drainage, and length of hospital stay following both MSLD flap and CLD flap breast reconstruction. RESULTS: The demographic data of the 2 groups were not significantly different. Donor-site seroma occurred in 2 MSLD patients (13.3%) and in 6 CLD patients (40.0%). The total volume of the drain discharge and the indwelling period of drainage at donor site were significantly lower in the MSLD group. The length of hospital stay was significantly shorter (by approximately a day and a half) for the MSLD group. CONCLUSION: The MSLD flap, with its low complication rate and associated minimal functional and aesthetic deficits at the donor site, may be a useful option for small breast reconstruction if earlier discharge from hospital is demanded.

Reliability and Validity of a New Method for Isometric Back Extensor Strength Evaluation Using A Hand-Held Dynamometer

OBJECTIVE: To investigate the reliability and validity of a new method for isometric back extensor strength measurement using a portable dynamometer. METHODS: A chair equipped with a small portable dynamometer was designed (Power Track II Commander Muscle Tester). A total of 15 men (mean age, 34.8±7.5 years) and 15 women (mean age, 33.1±5.5 years) with no current back problems or previous history of back surgery were recruited. Subjects were asked to push the back of the chair while seated, and their isometric back extensor strength was measured by the portable dynamometer. Test-retest reliability was assessed with intraclass correlation coefficient (ICC). For the validity assessment, isometric back extensor strength of all subjects was measured by a widely used physical performance evaluation instrument, BTE PrimusRS system. The limit of agreement (LoA) from the Bland-Altman plot was evaluated between two methods. RESULTS: The test-retest reliability was excellent (ICC=0.82; 95% confidence interval, 0.65–0.91). The Bland-Altman plots demonstrated acceptable agreement between the two methods: the lower 95% LoA was −63.1 N and the upper 95% LoA was 61.1 N. CONCLUSION: This study shows that isometric back extensor strength measurement using a portable dynamometer has good reliability and validity.

Evaluation of Histological Changes in Back Muscle Injuries in Rats over Time

STUDY DESIGN: Animal model study. PURPOSE: The purpose of this study was to evaluate the histological variation in the injured muscle and production of calcitonin gene-related peptide in rats over time. OVERVIEW OF LITERATURE: Vertebral surgery has been reported to cause atrophy of the back muscles, which may result in pain. However, few reports have described the time series histological variation in the injured muscle and changes in the dominant nerve. METHODS: We used 30 male, 8-week-old Sprague-Dawley rats. The right and left sides of the paravertebral muscle were considered as the injured and uninjured sides, respectively. A 115 g weight was dropped from a height of 1 m on the right paravertebral muscle. Hematoxylin and eosin (H&E) staining of the muscle was performed 1–3 weeks after injury for histological evaluation. Fluoro-Gold (FG) was injected into the paravertebral muscle. The L2 dorsal root ganglia on both sides were resected 1, 2, and 3 weeks after injury, and immunohistochemical staining for calcitonin gene-related peptide was performed. RESULTS: H&E staining of the paravertebral muscle showed infiltration of inflammatory cells and the presence of granulation tissue in the injured part on the ipsilateral side 1 week after injury. Muscle atrophy occurred 3 weeks after injury, but was repaired via spontaneous replacement of muscle cells/fibers. In contrast, compared with the uninjured side, the percentage of cells double-labeled with FG and calcitonin gene-related peptide in FG-positive cells in the dorsal root ganglia of the injured side was significantly increased at each time point throughout the study period. CONCLUSIONS: These results suggest that sensitization of the dominant nerve in the dorsal root ganglia, which may be caused by cicatrix formation, can protract injured muscle pain. This information may be helpful in elucidating the underlying mechanism of persistent pain after back muscle injury.

The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study

BACKGROUND: Donor site seroma is the most common complication after latissimus dorsi (LD) flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT) in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction. METHODS: In this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated. RESULTS: In the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24). Both the mean percutaneous aspirated volume (P=0.004) and the number of percutaneous aspirations (P=0.001) were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05). CONCLUSIONS: This study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.