Combined TRAM flap with latissimus dorsi myocutaneous flap for reconstruction of a large breast post-radiation induced necrosis.

Radiation therapy is a critical component of breast cancer management following breast-conserving surgery. Post-radiation sequelae are greater in women with larger breasts, given the need for higher doses and dosing heterogeneity. The goal of breast reconstruction post-mastectomy is to improve the quality of life and add no more health risk. The optimal reconstruction should make the patient feel as natural as possible. Reconstruction of a large-sized breast with aesthetically satisfactory outcome poses a challenge to the breast surgeon. The breast of most Egyptian women is of a large volume with variable degrees of ptosis, thus it is difficult to reconstruct such a large-ptotic breast using an implant. We describe the successful reconstruction of a large-sized breast after radiation-induced necrosis using a combined transverse myocutaneous rectus abdominis flap and latissimus dorsi myocutaneous flap reconstruction. The combined use of both flaps offered a more natural breast reconstruction and avoided the use of any implants.

Squamous cell carcinoma of the heel with free latissimus dorsi myocutaneous flap reconstruction: case report and technical note.

Squamous cell carcinoma (SCC) is the second most common skin cancer; however, it is relatively rare on the foot. Wide excision of SCC is the recommended surgical treatment. The extent of the excision may involve resection of muscles and bone in cases of deep lesions. The functional and anatomic properties and lack of sufficient locally available tissues make the reconstruction of post-oncosurgical defects of the foot a challenging process. Heel reconstruction poses the biggest challenge due to the unique weight-bearing requirements. We present a case of a Marjolin's ulcer on the heel in a 62-year-old woman complicating a chronic non-healing wound. The heel defect was reconstructed with a free latissimus dorsi myocutaneous flap with delayed secondary closure. The outcome was successful both functionally and cosmetically. No further procedures were needed.

Langer's arch: a rare anomaly affects axillary lymphadenectomy.

Langer's arch is the best-known anatomic variant of definite surgical implication in the region of the axilla. This rare anomaly is a muscular slip extending from the latissimus dorsi (LD) muscle to the tendons, muscles or fasciae around the superior part of the humerus. In this report, we present a rare case of left axillary arch. During modified radical mastectomy for breast cancer, we encountered an abnormal muscle slip crossing the axilla from the LD muscle to the posterior surface of the pectoralis major muscle anterior to the neurovascular structures. Preoperative knowledge is essential to identify such unusual anomaly and avoid potential complications both intra- and postoperatively.