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Chest wall deformities
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert E. Kelly, Marcelo Martinez-Ferro, Horacio Abramson
Figure 20.41 is a schematic depiction of a severe deformity with rotation of the sternum and aplasia of three ribs. Ironically, the contralateral side of the chest may have a carinate protrusion which accentuates the depression on the ipsilateral side. The rotation of the latissimus dorsi muscle that is occasionally utilized in males has the potential drawback of decreasing strength of the shoulder.
Advanced autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The patient is positioned in the lateral decubitus position with the ipsilateral arm prepped and placed on a sterile Mayo stand. An axillary roll is placed to avoid contralateral brachial plexopathy. The boundaries of the latissimus dorsi muscle are marked.
The breast
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The easiest type of reconstruction is using a silicone gel implant under the pectoralis major muscle. The lateral portion of the implant, which was traditionally left in the subcutaneous plane, is now increasingly covered by an acellular dermal matrix (ADM). This gives a superior cosmetic result. Prior tissue expansion using an expandable saline prosthesis first (or a combined device), creates some ptosis of the new breast. If the skin at the mastectomy site is poor (e.g. following radiotherapy) or if a larger volume of tissue is required, a musculocutaneous flap can be constructed either from the latissimus dorsi muscle (an LD flap) (Figure53.29) or using the transversus abdominis muscle (a TRAM flap as shown in Figure53.30). The latter gives an excellent cosmetic result in experienced hands but is a lengthy procedure and requires careful patient selection. It is now usually performed as a free transfer using microvascular anastomosis, although the pedi- cled TRAM from the contralateral side is still used. Variations on the TRAM flap requiring less muscle harvesting, such as the DIEP flap (based on deep inferior epigastric vessels), are increasingly being used.
BOBATH vs. TASK-ORIENTED TRAINING AFTER STROKE: An assessor-blind randomized controlled trial
Published in Brain Injury, 2023
Gülşah Sütçü, Levent Özçakar, Ali İmran Yalçın, Muhammed Kılınç
The exercises were planned by a therapist with 20 years of Bobath experience. According to the Bobath concept, trunk control has critical significance in terms of proximal stabilization in voluntary movements of the extremities, balance and mobility activities (5). Therefore, functional exercises that activate the trunk bilaterally in line with the needs of patients were selected as follows: Functional strengthening of trunk musclesStretching the latissimus dorsi muscleScapular mobilizationPlacing exercises to facilitate trunk extensionRotations of the trunk and extremities with trunk extensionFunctional reach of the upper extremity in different directionsFunctional exercises for extremitiesWeight transfers for upper and lower extremitiesGait and balance exercises
Rare case of low-grade fibromyxoid sarcoma of the thoracic wall with complete sternum reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
João Nunes Pombo, Artur Nixon Martins, Catarina Paias Gouveia, Ágata Nawojowska, Samuel Mendes, Daniel Cabral, Francisco Félix, Bruno Rosa, Carlos Pinheiro, Miguel Andrade, Gaizka Saenz Ribeiro
Sternal reconstruction is essential for protection of the mediastinal contents, stabilization of the thorax and for maintenance of respiratory physiology. Usually, titanium plates or meshes are the chosen method for reconstruction but molding of the plates is dependent on surgeon’s experience. Recently, there has been an interest in developing 3 D printed custom-made prostheses for total sternum reconstruction [16]. These prostheses have evolved from titanium to high-density porous polyethylene (StarPore™ – Anatomics™), which is significantly lighter and more flexible. It also allows intraoperative modification and fast tissue integration [15]. We have selected a StarPore™ prostheses, manufactured from a preoperative CT of the patient. For soft tissue reconstruction a latissimus dorsi muscle free flap was chosen as it presented adequate size and thickness to fully cover the prosthesis and the soft tissue defect.
Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report
Published in Physiotherapy Theory and Practice, 2022
Fabrizio Brindisino, Firas Mourad, Filippo Maselli
The patient underwent surgery 3 weeks after her physiotherapy consultation. She was positioned in prone, under general anesthesia, with ipsilateral arm draped freely to allow better access to the lesion. The latissimus dorsi muscle was split with a transverse incision over the lesion and the serratus anterior muscle was accessed. Hard white tissue with uncertain margin that was firmly attached to the serratus anterior and periosteum of the fourth, fifth, sixth and seventh ribs and was separated using electrocautery. Marginal resection was performed (Figure 5(a-c)). To avoid the main complications of this surgical procedure such as hematoma and seroma ranging from 11.8% to 35.1% especially in the case of EF with large diameter, a suction drain was kept in place for 2 days after resection and a pressure dressing was applied. The patient was prescribed an arm sling for 1 week after surgery. A biopsy is in general not necessary but analyzing a small piece of the EF to further ensure the benign nature of the tumor is advisable and was done in this case.