• Maxillofacial Plastic and Reconstructive Surgery
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• v.14 no.1_2
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• pp.105-116
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• 1992

Latissimus dorsi myocutaneous flap is useful for the breast reconstruction, chest wall coverage, free flap transfer, and head and neck area reconstruction, especially in large defect. We have had some experience of 5-pedicled and 1-free latissimus dorsi myocutaneous flap in head and neck area and found many advantages and some problems. The conclusions were as follows : 1. Potentially large flap size enabled us agressive tumor resection and reconstruction. 2. Speedy and easy flap elevation and long vascular pedicles reduced operation time and flap failure. 3. Due to fewer complication and functional loss of doner site, pedicled latissimus dorsi flap was a good choice for large head and neck reconstruction. 4. Because of flap bulkness, thin and small defect was not appropriate for reconstruction.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.35-40
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• 1998

The incidence of brachial plexus injury is increasing because of the development of motor vehicle but the the results of treatment was reported poor due to its complex anatomical structure and changes of function and sensory during the recovery after trauma. But the results of treatment has been improved by the recently introduced high sensitive diagnostic method that can evaluate accurately the site and extent of the injury and treatment method. Restoration of the elbow flexion is the most important goal of treatment after brachial plexus injury and nerve graft, neurotization and muscle transfer were used for methods of treatment. From December 1992 to May 1994, the author performed 6 cases of latissimus dorsi transfer at the same side for the improvement of elbow flexion in the patients of brachial plexus injury. There were 5 cases of male, one case of female and average age was 22 years old. The causes of injury were traffic accident in 3 cases, gun shot injury, falldown and birth injury in each one case and in all cases, the type of injury were upper arm type. The average follow up period were 1 year 5 months ranging from 12 months to 4 years 5 months. In all cases, active elbow flexion was impossible before operation and average muscle power was grade I. We analysed the active range of motion, muscle power and the functional results. At the last follow up, range of active elbow flexion was average $124^{\circ}$ and flexion contracture was average 11 degrees and the average of muscle power was grade IV. In the functional analysis, there were two cases of excellent, three cases of good and 1 case of fair. There was no complications including wound infection, vascular compromise and donor site problem. The results of latissimus dorsi transfer for improvement elbow flexion in the patients of brachial plexus injury is one of the useful mettled for the restoration of elbow flexion.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.423-426
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• 2012

Spinal infection is an inflammatory process around the vertebral body, and it can extend to the epidural space, posterior elements and paravertebral soft tissues. Infectious spondylitis is a rare infectious disorder, which is often associated with significant neurologic deficits and mortality. When an extensive soft tissue defect is accompanied by infectious spondylitis, effective infection control and proper coverage of soft tissue are directly connected to successful outcomes. However, it is not simple to choose the appropriate treatment methods for infectious spondylitis accompanied by a soft tissue defect. Herein, we report a case of severe infectious spondylitis that was accompanied by an extensive soft tissue defect which was closed with a reverse latissimus muscle flap after traumatic spinal epidural hemorrhage.

• Korean Journal of Applied Biomechanics
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• v.20 no.3
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• pp.277-284
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• 2010

The purpose of this study was to investigate the trunk rotation type by wheel and axle. In order to analysis, 3D-motion analysis and electromyography were conducted on kinematic variables, impulse, average-EMG and integrated-EMG. Twelve healthy (age: $21.8{\pm}2.2$ yrs, height: $175.4{\pm}5.0cm$, weight: $66.7{\pm}6.4kg$) participated in the experiment. The results were as follows; in hand's velocity and acceleration, wheel and axial rotating movement using kinematic chain(type 3) were much faster. In impulse, type 3 was much stronger. In average-EMG, right and left, latissimus dorsi muscles was much stronger. In integrated-EMG, left erector spinae, right/left latissimus dorsi, and left external oblique muscles was much stronger. These results considered that, in the trunk rotation utilizing the kinematic chains action, latissimus dorsi muscles highly contribute to the muscle utilization that makes the rotating movement maximally effective.

• Archives of Craniofacial Surgery
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• v.16 no.2
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• pp.80-83
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• 2015

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.

• Archives of Plastic Surgery
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• v.42 no.1
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• pp.73-77
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• 2015

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.124-128
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• 2016

A 7-year-old intact female Maltese dog presented with a history of bite wounds. Physical examination revealed labored breathing, four puncture wounds with subcutaneous emphysema of the thorax, and paradoxical respiratory movement of the right thoracic wall. On radiography, a segmental fracture of the right 7th rib and a single fracture of the 8th rib were evident on the dorsal thorax. An inward displacement of the fractured segment and contusion of the right caudal lung lobe were identified with computed tomography. A diagnosis of pseudo-flail chest was made. Exploratory thoracotomy revealed a full-thickness muscular defect, a marked discoloration of the right caudal lung lobe, a segmental fracture of the right 7th rib, and a single fracture of the right 8th rib. Necrotic tissues were removed using surgical debridement. The fractured 7th and 8th ribs were corrected using a single interfragmentary wiring technique. The thoracic wall was reconstructed using the latissimus dorsi muscle flap. Additional thoracic stabilization using a thermoplastic splint was applied to correct paradoxical respiratory movement. The external splint was removed 4 weeks postoperatively. There was no evidence of respiratory abnormalities 18 months postoperatively.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.577-582
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• 2021

Robot-assisted surgery is evolving to incorporate a higher number of minimally invasive techniques. There is a growing interest in robotic breast reconstruction that uses autologous tissue. Since a traditional latissimus dorsi (LD) flap leads to a long donor scar, which can be an unpleasant burden to patients, there have been many attempts to decrease the scar length using minimally invasive approaches. This study presents the case of a patient who underwent a robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction with an LD flap using a single-port robotic surgery system. With the assistance of a single-port robot, a simple docking process using a short and less visible incision is possible. Compared to multiport surgery systems, single-port robots can reduce the possibility of collision between robotic arms and provide a clear view of the medial border of the LD where the curvature of the back restricts the visual field. We recommend the use of single-port robots as a minimally invasive approach for harvesting LD flaps.

• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.340-345
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• 2023

Objective: The purpose of this study was to investigate the effect of thoracic spine and ankle joint alignment on trunk and upper limb muscle activity during trunk forward lean exercise using a sling. Methods: 25 subjects participated in this study. All subjects performed trunk forward lean exercise using a sling under four conditions according to the alignment of the thoracic spine and ankle joints. Trials were performed 3 times in each condition. Muscle activity of the trunk and upper extremity was measured using electromyography. Results: In the dorsiflexion, the thoracic kyphosis condition showed significantly higher muscle activity in the pectoralis major, rectus abdominis, latissimus dorsi, transverse abdominis than dorsiflexion(p<0.05). In the plantar flexion, thoracic kyphosis condition showed significantly higher muscle activity in pectoralis major, transverse abdominis, latissimus dorsi muscle activity than dorsiflexion(p<0.05). Conclusions: Regardless of ankle alignment, thoracic kyphosis condition increased the activity of the pectoralis major, transverse abdominis, latissimus dorsi. Therefore, regardless of the alignment of the ankle, it is recommended to perform the trunk forward lean exercise using a sling in thoracic kyphosis.

• Physical Therapy Korea
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• v.13 no.2
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• pp.35-42
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• 2006

The walker provides stability for walking for people whose lower extremities are disabled. It is important to measure and determine the appropriate height of a walker to conserve energy and to improve function. The purposes of this study were to examine effects of walker height and gait velocity on triceps, latissimus dorsi muscle activation, and energy expenditure index (EEI) during ambulation with a walker. Fifteen healthy subjects participated in this study. Each subject was assigned a walker with one of three heights (high, standard, lower height) and of two gait velocities (comfortable gait velocity or fast gait velocity). Electromyographic data were collected from triceps and latissimus dorsi, and EEI was determined from each condition. Two-way repeated analysis of variance (ANOVA) was used to determine the statistical significance. Post hoc comparison was performed with the Bonferroni test. The results of this study were summarized as follows: 1. There was a significant difference in the %MVIC of triceps among different walker height factors. Post hoc comparison revealed that %MVIC of dominant triceps brachii was more significantly increased in patients who used the higher walker than those who used the lower walker (p<.05). 2. There were significant differences in the %MVIC of the latissimus dorsi among different walker height factors and gait velocity factors. Post hoc comparison revealed that the %MVIC of dominant latissimus dorsi was also more significantly increased in patients who used the higher walker than those who used the lower walker (p<.05) and in those who used the faster gait velocity than those who used the slower gait velocity (p<.05). 3. There were significant differences in the EEI among different walker height factors and gait velocity factors. Post hoc comparison revealed that the EEI was significantly increased among those who used higher and lower walkers compared with the standard walker. The EEI was also more significantly increased among those who used the fast gait velocity than those who used the slower gait velocity (p<.05). It has been concluded that increased muscle activation in triceps and latissimus dorsi was required when the walker height increased and that more energy was exp ended when the gait velocity increased. Therefore, from the findings of this study, it is recommended that walker height be adjusted according to the purposes of gait training and that healthy subjects conserve energy when ambulating with standard walkers in a comfortable gait velocity.