Brachial Plexus Examination
J. Terrence Jose Jerome in Clinical Examination of the Hand, 2022
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).
Chest Trauma, Iatrogenic Trauma including drainage tubes and some Post-surgical Conditions and Complications of Radiotherapy.
Fred W Wright in 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.
Malignant breast disease
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
The thoracodorsal nerve to the latissimus dorsi and the long thoracic nerve should be identified close to the chest wall and preserved. The axillary contents are then dissected away from the nerves and accompanying arteries and removed en bloc. The intercostobrachial nerve crosses the mid-axillary region and should also be preserved, although it may be divided if necessary, giving some paraesthesia to the medial part of the upper arm.
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.
Related Knowledge Centers
- Back
- Brachial Plexus
- Latissimus Dorsi Muscle
- Spinal Nerve
- Nerve
- Cervical Spinal Nerve 6
- Cervical Spinal Nerve 7
- Cervical Spinal Nerve 8
- Ventral Ramus of Spinal Nerve
- Posterior Cord