Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction

Abstract

Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.

Sihler's staining technique: How to and guidance for botulinum neurotoxin injection in human muscles

“…The muscle had the largest nerve distribution between the medial and lateral parts of the muscle ranging from the 4/10th to the 6/10th portions, the middle part from the 3/10th to 6/10th portions, and the medial, middle, and lateral parts from the 7/10th to 9/10th portions. (Figure 11) (Yi, Lee, Seo, & Kim, 2022).…”

“…Previous studies have demonstrated that botulinum neurotoxin injections in flap surgeries lower the risk of necrosis and allow for the further expansion of arterial cross‐sectional diameters (Yi, Lee, Seo, & Kim, 2022). The arborization patterns of the intramuscular nerves of the rectus abdominis muscle were determined based on the most prominent point of the xiphoid process (0/10) to the pubic crest (10/10).…”

Distribution of the intramuscular innervation of the triceps brachii: Clinical importance in the treatment of spasticity with botulinum neurotoxin

“…Intramuscular distribution‐based injections have demonstrated superior effectiveness in clinical studies of the biceps brachii and psoas major muscles, with a much higher volume reduction than that in the control group (Gracies et al, 2009; Van Campenhout et al, 2013). There have been many articles published to suggest injection points using BoNT (Yi et al, 2020; Yi, Lee, Hu, & Kim, 2022; Yi, Lee, Hur, Seo, & Kim, 2022; Yi, Lee, Kim, Yoon, et al, 2022; Yi, Lee, Seo, & Kim, 2022b).…”

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

“…Numerous studies on BoNT injection points in muscles have previously been published on external anatomical standards ( Figure 2 ) [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. We searched for articles using the following keywords: “botulinum neurotoxin in nose region” and “side effect of botulinum neurotoxin injection in nose wrinkle” on Pubmed and Scopus.…”