Use of a latissimus dorsi flap for treatment of infection in a neuropathic shoulder joint

Meiners, Thomas

doi:10.1038/sj.sc.3101470

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Using the latissimus dorsi muscle flap in the upper extremity resulted in satisfactory functional recovery [16]. But there is still a lack of scientific knowledge about strength values, imbalances and intermuscular coordination after surgery in the shoulder girdle using latissimus dorsi muscle.…”

Section: Discussionmentioning

confidence: 99%

Funktionelles Resultat und biomechanische Untersuchungen nach Tumor-Resektion im Bereich des Schultergürtels (Fallbericht)

et al. 2009

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Zusammenfassung. Grundlagen: Es wird ein 20-jähriger Mann vorgestellt, der wegen eines ausgedehnten Desmoidtumors im Schulterbereich marginal reseziert worden ist und intra-und postoperativ nachbestrahlt wurde.Methodik: Weite Teile des Schultergürtels waren von Tumorgewebe infiltriert weshalb der ventrale Teil des M. deltoideus, zwei Drittel des M. pectoralis major, der M. pectoralis minor, das Schlüsselbein und Teile der Kapsel des Schultergelenks entfernt wurden. Die Rekonstruktion der Muskelfunktion erfolgte durch einen gesplitteten M. latissimus dorsi, welcher mit Meshgraft bedeckt wurde.Ergebnisse: 3 Jahre postoperativ ist der Mann als Bäcker voll berufstätig, lediglich die Adduktion ist durch das Fehlen des Schlüsselbeins eingeschränkt. Am Institut für Sportwissenschaft wurde die globale Schulterfunktion gemessen und das klinisch gute Ergebnis bestätigt.Schlussfolgerungen: Ausgedehnte Tumorresektionen im Schulterbereich sind heute bei guter Planung und radikaler Durchführung der Operation mit einzeitiger Rekonstruktion und sehr früh postoperativ eingesetztem Rehabilitationsprogramm möglich. Sportmedizinische Messungen der globalen Schulterfunktion können zur Optimierung des Rehabilitationsprogramms wertvolle Hinweise liefern. Schlüsselwörter: Tumor, Schultergü rtel, Rekonstruktion, gesplitteter M. latissimus dorsi-Lappen, funktionelles Ergebnis, biomechanische Untersuchungen. Summary. Background: A 20-year-old male with a large extra-abdominal fibromatosis of the left shoulder girdle underwent marginal tumor resection, postopoperative radiation therapy and reconstruction with a split latissimus dorsi flap.Methods: Owing to the tumor involving major parts of the shoulder girdle, the clavicular part of the deltoideus and cranial parts of the pectoralis major and pectoralis minor muscle, parts of the coracobrachial muscle, the clavicle and the coracoid process had to be resected. The reconstruction of the different muscles was performed with a split latissimus dorsi muscle (LD) covered with mesh graft. The LD flap was chosen for its size, ability for compartmentalization, arc of rotation, vascularization and innervation and minimal donor-site morbidity. Owing to the marginal resection of the tumor, intra-and postoperative radiation therapy followed.Results: The patient has regained excellent function in his left upper extremity and is able to continue his profession as a baker with the exception of adduction being weaker than the contralateral side caused by the missing clavicle.Conclusions: The transfer of a split latissimus dorsi muscle is an effective procedure to cover defects and restore muscles with different function after extended tumor resection in the region of the shoulder girdle. The functional outcome is excellent and measurements by sport scientists are able to gain valuable results for optimizing the rehabilitation program.

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Section: Discussionmentioning

confidence: 99%

Funktionelles Resultat und biomechanische Untersuchungen nach Tumor-Resektion im Bereich des Schultergürtels (Fallbericht)

et al. 2009

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“…In these patients, the use of a muscle to cover the wound and fill the dead space can help provide a better seal for improved wound healing and infection control [31]. Previously reported flaps used for local coverage of deep shoulder wounds following rotator cuff repair include the latissimus dorsa and pectorals major, both of which have been reported to have favourable outcomes [29][30][31]. Modern reconstructive literature indicates that utilization of well vascularized fasciocutaneous flaps is equivalent to use of a muscle flap for wound coverage, and the choice of the regional flap is at the discretion of the reconstructive surgeon [32][33][34][35][36].…”

Section: Resultsmentioning

confidence: 99%

“…In cases of synovia-cutaneous fistulas, the use of a vascularized muscle flap is advantageous to obliterate dead space, treat osteomyelitis, and provide adequate bulky coverage of orthopaedic hardware [27,28]. The consideration for use of vascularized tissue is even more important for cases where there is suspicion for an underlying infection [29,30]. A study published by Mirzayan et al details the use of my cutaneous flaps in 7 patients with deep shoulder infections [31].…”

Section: Casementioning

confidence: 99%

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Rl¹,

Kj²,

Nl³

et al. 2016

Bone Rep Recommendations

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Context: The treatment of rotator cuff tears has become one of the most common orthopaedic sports procedures. The development of a synovio-cutaneous fistula is a rare, but serious, complication that has been described after rotator cuff repair. The purpose of this report is to present the local rotational flap as a treatment option for synovio-cutaneous fistulas of the shoulder and to emphasize the importance of recognizing when primary closure may not be sufficient for adequate repair.Case Reports: A 67-year-old male who previously underwent a right rotator cuff and a biceps tendon repair presented with a persistently draining shoulder fistula. The decision was made to proceed with extensive debridement and closure using vascularized tissue. A 63-year-old male presented for a postoperative wound complication following attempted open debridement of a left torn rotator cuff. The wound was initially managed conservatively, but a persistently draining fistula necessitated the use of vascularized tissue for closure of the wound. The recovery of both patients was uneventful with no recurrent fistula formation. Both patients had improved shoulder range of motion following surgery and resolution of their pain. Conclusions:The excessive tension placed on the rotator cuff tendons and deltoid during repair and the resultant inflammation may contribute to tissue necrosis and facial dehiscence over the glen humeral joint, allowing for fistula formation. Surgeons should be aware that when adequate soft tissue coverage cannot be accomplished over the glen humeral joint via primary closure, there are local flaps available to provide complete coverage over the joint.

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Results of combined vascular reconstruction by means of AV loops and free flap transfer in patients with soft tissue defects

Meyer

Horch

Schoengart

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Use of a latissimus dorsi flap for treatment of infection in a neuropathic shoulder joint

Cited by 4 publications

References 16 publications

Funktionelles Resultat und biomechanische Untersuchungen nach Tumor-Resektion im Bereich des Schultergürtels (Fallbericht)

Funktionelles Resultat und biomechanische Untersuchungen nach Tumor-Resektion im Bereich des Schultergürtels (Fallbericht)

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Results of combined vascular reconstruction by means of AV loops and free flap transfer in patients with soft tissue defects

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