The breast
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
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.
Chest wall deformities
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
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.
The Skin and Muscles of the Back
Gene L. Colborn, David B. Lause in Musculoskeletal Anatomy, 2009
The latissimus dorsi muscle arises from spines of the lower thoracic, lumbar and sacral vertebrae, the posterior part of the iliac crest and the lower four ribs (Table 2:1). It inserts upon the intertubercular groove of the humerus - acting to extend and adduct the arm and to rotate it medially. This muscle is particularly active in exercises such as chinups.
Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Takeshi Kitazawa, Masato Shiba, Kazuhiro Tsunekawa
The serratus fascial flap was first described as a tendon gliding material for coverage of exposed flexor tendons at the forearm or wrist level by Wintsch and Helaly [8]. This flap has since seen frequent application to dorsal hand coverage together with skin grafts because of its thinness, long and constant vascular pedicle, and low donor-site morbidity [9–14]. The angular branch that nourishes the lower part of the scapula in the present two cases arose from the serratus anterior branch of the thoracodorsal artery. According to Seneviratne et al. [15], the same branching pattern was observed in only 25% of dissections. Branching from the latissimus dorsi muscle pedicle was seen in more than half of their specimens. However, Seitz et al. [16] noted that the angular branch mostly arose from the serratus branch (48.5% of their cadaver dissections). Either way, the independence of pedicles between fascia and bone facilitates flap positioning.
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.
Correlation of New Criteria for Malnutrition Assessment in Hospitalized Patients: AND-ASPEN Versus SGA
Published in Journal of the American College of Nutrition, 2020
Peggy Hipskind, Mary Rath, Andrea JeVenn, Marianne Galang, Alaa Nawaya, Elizabeth Smith, Rocio Lopez, Gail Cresci
The NFPE encompasses assessment of 8 body regions and frequently not all of these regions are accessible for evaluation due to the medical condition or status of the patient. Therefore, data was obtained for how frequently clinicians assessed each region of the body during the physical exam component of the AND-ASPEN criteria to assist with determining if all 8 body regions were required for accurate assessment of malnutrition. Only 20% of subjects had documentation in the EMR for all 8 NFPE areas. Body locations least likely to be assessed were latissimus dorsi muscle and fat located at the mid-axillary line above the iliac crest (Figure 4). Most frequently assessed areas included: temporalis, pectoralis, interosseous, and deltoid muscles, as well as orbital and triceps fat. Unlike the comprehensive NFPE inherent to the AND-ASPEN criteria technique, the NFPE component of SGA only includes four body regions: deltoids, quadriceps for muscle and iliac crest area and triceps for fat (13). Of the 409 patients, 55% had all four of these physical exam areas documented. In this study, only three of the SGA areas were frequently examined, with iliac fat area least likely to be assessed (Figure 4).
Related Knowledge Centers
- Axillary Artery
- Coracobrachialis Muscle
- Shoulder Joint
- Pectoralis Major
- Trapezius
- Bodybuilding
- Pull-Up
- Anatomical Terms of Muscle
- Axillary Arch
- Biceps