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Chest Trauma, Iatrogenic Trauma including drainage tubes and some Post-surgical Conditions and Complications of Radiotherapy.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
An intercostal incision which extends posteriorly may damage the long thoracic nerve leading to atrophy of the serratus anterior and a 'wingedscapula'. Similarly damage to the thoracodorsal nerve may lead to atrophy of the latissimus dorsi (see Goodman, P. et al., 1993 and Frola et al., 1995); this muscle may also be deformed after cardiomyoplasty, when it is 'wrapped around the heart' to increase vascularity. See also Bhalla et al. (1994) - Surgical flaps in the chest.
Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
The posterior cord gives off the upper subscapular nerve, the thoracodorsal nerve and the lower subscapular nerve. The upper and lower subscapular nerves innervate the upper and lower portions of the subscapularis respectively, which provides shoulder internal rotation. The lower subscapular nerve also innervates the teres major which is a shoulder adductor. The thoracodorsal nerve innervates the latissimus muscle, which helps to adduct, extend and internally rotate the shoulder (Table 12.1).
Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
The brachial plexus runs along the course of the subclavian and axillary arteries and can be encountered with exposure of either of these vessels. The posterior and medial cords of the brachial plexus run inferior to the subclavian artery, which splits these as it passes below the clavicle. The superior, middle, and inferior trunks of the brachial plexus surround the axillary artery on 3 of its 4 sides. Occasionally, one of the trunks can run anterior to the axillary artery, and no cord-like structures should be divided during the dissection. Injuries to the brachial plexus are clinically divided into branches of the upper plexus and the lower plexus. Injuries to the upper plexus can manifest as the “waiter's tip” position with the arm abducted, the shoulder internally rotated the elbow extended and the forearm pronated.19 Injuries of the lower plexus can affect the thoracodorsal nerve leading to inability to adduct the shoulder or portions of the radial, median, and ulnar nerves.
Latissimus Dorsi Myocutaneous Flap Procedure in a Swine Model
Published in Journal of Investigative Surgery, 2021
Joanna W. Etra, Samuel A. J. Fidder, Christopher M. Frost, Franka Messner, Yinan Guo, Dalibor Vasilic, Sarah E. Beck, Steven Bonawitz, Gerald Brandacher, Damon S. Cooney
The muscle is bordered by the slightly superficially overlapping trapezius muscle cranial-dorsally, the underlying serratus on the caudal and ventral sides, and the triceps muscle where the tendon dives to insert onto the humerus (Figures 1 and 3, Panel 3). The latissimus muscle fans from its insertion in the posterior axillary fold superficial to a fascial layer. The neurovascular bundle – containing the thoracodorsal artery, vein, and nerve – is found on the deep surface of the muscle superficial to the fascia (Figure 4). The pedicle runs deep to the teres major and enters the latissimus muscle distal to its tendon origin [17,18]. The thoracodorsal nerve – which supplies the motor innervation for the latissimus muscle – runs parallel to the vascular bundle inserting slightly more cranially. The nerve is easily identified and accessed for a neurotized flap model.
Muscle flaps for sternoclavicular joint septic arthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Barkat Ali, Timothy R. Petersen, Anil Shetty, Christopher Demas, Jess D. Schwartz
Latissimus dorsi is the next local flap option for closure of sternoclavicular joints. This is a type V flap which consists of a large vascular pedicle, and known secondary pedicles. The thoracodorsal artery is the main pedicle, with secondary pedicles from the posterior intercostal artery. Innervation is through the thoracodorsal nerve [23]. If pectoralis major muscle is not available because of pedicle sacrifice, or there is need for skin paddle, or there is need for more bulk in addition to the pectoralis major, then we recommend latissimus dorsi based on thoracodorsal pedicle. Although skin graft can be performed over pectoralis muscle flap, in our experience bringing skin paddle with latissimus dorsi is more aesthetically pleasing and potentially offers faster recovery. The functional deficit following latissimus dorsi flap is insignificant [24]. The two patients who needed latissimus dorsi flaps in our series were because of the unavailability of the pectoralis major muscle from previous operations, including one patient who needed skin paddle resulting from debridement of the skin
The use of Fat-Augmented Latissimus Dorsi (FALD) flap for male Poland Syndrome correction: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Fabio Santanelli di Pompeo, Michail Sorotos, Guido Paolini, Gennaro D’Orsi, Guido Firmani
The reconstructive process consisted of a pedicled FALD flap. The preoperative markings were performed the day prior to surgery, with the patient in the upright position. The largest possible transverse skin paddle was drawn on the back (19.0 cm × 8.0 cm) using the pinch test. The major axis of the skin paddle was drawn slightly tilted compared to an imaginary transverse horizontal line, which allowed an easy closure of the donor site. The surgery started with the patient in right lateral decubitus position and with the left upper limb suspended at a right angle, to provide adequate axillary access. The skin paddle was first de-epithelialized, then its edges were incised perpendicularly through the Scarpa’s fascia and down to the muscle fascia. The LD muscle was then harvested in its entirety, dissecting proximally up to the insertion tendon on to the intertubercular groove of the humerus, keeping the thoracolumbar fascia intact on the back. The thoracodorsal pedicle was identified from below, isolated and dissected proximally, until reaching the required length for tension-free flap transposition. The thoracodorsal nerve was not sectioned to avoid late muscle atrophy, in order to perform a functional reconstruction of the left thoracic wall. A suction drain was placed at the donor-site, which was closed in two layers. An incision was performed on the left thoracic wall to provide an adequate view of the recipient site and avoid pneumothorax or pericardial injury. The recipient area was prepared, extending dissection from the anterior axillary line to the left parasternal line and from the manubrium to the xiphisternal line.