带神经血管蒂的背阔肌移位治疗三角肌瘫痪

目的：对背阔肌移位治疗三角肌瘫痪的临床疗效进行分析和比较，以探讨治疗三角肌瘫痪的最佳方法。方法：用带神经血管蒂的背阔肌肌瓣移位代替瘫痪的三角肌，近端固定在锁骨的外１／３、肩峰、肩胛冈，远端固定在三角肌结节的下方。术后肩外展９０°，前屈３０°位固定。术后１周开始肌肉的主动运动，逐步增加肌肉的收缩力，四周后去除外固定。结果：本组５例术后移位肌肉肌力均达Ⅲ级以上，３例肩关节上举＞７０°，２例５０°～７０°。结论：带神经血管蒂的背阔肌移位代替三角肌是一种治疗三角肌瘫痪的较好的手术方式，其临床疗效优于其他方法。     

背阔肌肌皮瓣双极移位重建屈肘屈指功能

１９８９年以来，我们应用带血管蒂的背阔肌肌皮瓣、肌瓣双极移位，重建屈肘屈指功能５例，术后肌皮瓣、肌瓣全部成活，功能恢复满意。一、资料与方法一般资料：本组５例，均为男性；年龄１９～３８岁。伤因：机器绞轧伤２例，汽车、摩托车撞伤２例，外伤引起的前臂缺血性挛缩１例。移位皮瓣面积：６～８０ｃｍｘ３０～３５ｃｍ。行背阔肌肌皮瓣双极移位，重建屈肘功能１例，屈指功能１例。背阔肌肌瓣移位重建屈肘功能３例。术后经多年随访，４例屈肘功能，屈曲度均在４０度左右，肌力均达Ⅴ级；肘关节伸直均达１６５度左右。１例屈指功能，…     

背阔肌移位重建屈肘功能术（二）

利用背阔肌移位重建屈肘功能由Schottstaedt(1955)和Hovnanian(1956)首先提出,背阔肌肌力强大,血管神经蒂粗大恒定、易于显露和保护,切口隐蔽,为屈肘功能重建中首选的肌肉动力来源。1 应用解剖背阔肌为扁平的三角形阔肌,位于腰背部和腋部,起自下六个胸椎、全部腰椎及骶椎的棘突和棘间韧带以及髂嵴后部,还有部分肌纤维起自肋骨及肩胛骨下角,背阔肌肌腱扁平,从前下方包绕大圆肌腱,止于肱骨结节间沟。背阔肌主要的血管神经为胸背动、静脉和胸背     

背阔肌双极移位重建产瘫儿童屈肘肌功能

目的：介绍和评价背阔肌双极移位重建臂丛神经产伤后屈肘肌功能障碍的手术方法和结果。方法：从1992年6月-2002年6月，本科共收治分娩性臂丛神经损伤病人36例，其中采取背阔肌双极移位治疗臂丛神经产伤后屈肘肌功能障碍10例，男4例，女6例，手术时平均年龄为7(5—12)岁，2例息儿在术后1年因肩关节连枷而行肩关节固定术。结果：本组10例病人术后平均随访3(1．5—6)年，肘关节屈曲肌力达到4级以上，手触嘴的功能均恢复，无神经血管束损伤等手术并发症。结论：臂丛神经产伤引起的屈肘肌功能障碍严重影响患儿的生活和学习能力，需要手术治疗。本组选择的背阔肌双极移位，具有操作相对简便、符合生物力学、并发症少和结果确实的优点，因此是一种值得推荐的手术方法。     

背阔肌皮瓣移位重建屈肘功能12例

自１９９１年３月￣１９９３年１０月，利用背阔肌移位重建臂丛神经损伤的屈肘功能１２例，随访６个月￣２年半，疗效满意。优点为：①不可逆性臂丛神经损伤肢体多为“皮包骨”，采用肌皮瓣移位，增大了肢体周径，减少了皮肤张力，有利于移位后肌肉滑行，改善了外观，同时也便于术后血运观察。②部分臂丛根性损伤，背阔肌多已萎缩无功能，利用神经移位重建胸背神经而恢复的背阔肌功能，再移位重建屈肘功能，证明是有效可行的。分析讨     

背阔肌皮瓣游离移植修复前臂重建功能

创伤致前臂屈肌或伸肌并皮肤广泛缺损,使患肢手部完全丧失功能,治疗上极为困难。我院从1987年开始应用吻合血管、神经的背阔肌肌皮瓣移植,修复前臂肌肉并广泛性皮肤缺损4例。术后随访6个月～3年,肌力恢复4级左右,外形和功能满意。 我们的方法是将背阔肌的腱性部分固定在肱骨内髁或外髁上,远端分成束,每一束与手指肌腱的远侧断端在张力下缝接。同时可应用肌腱移位重建1～2指功能以弥补背阔肌肌力的不足。对背阔肌修复前臂软组织缺损重建功能的优缺点、受区的准备、肌腱的处理等问题进行了讨论。     

背阔肌移位重建伸髋及稳定膝关节

本文报告8例病人用背阔肌移位法重建伸髋及稳定膝关节,文内对手术方法进行了介绍,并着重指出:背阔肌移位后收缩力仍很强大,用以替代一侧臀肌及大腿部肌群严重麻痹患者可以获得较好的治疗效果。     

The Latissimus Dorsi Flap for Reconstruction of a Paralysed Deltoid

A case with complete paralysis of the deltoid muscle with irreperable axillary nerve lesion was treated with a functional muscle transfer. The latissimus dorsi muscle was preparated as an island flap, turned over and sutured to the trapezius at one side and to the original deltoid insertion on the humerus at the other side. Function and cosmesis were excellent.     

Cardiomyoplasty: Preservation of the Latissimus Dorsi Muscle

ABSTRACT Muscle necrosis has been frequently observed in cardiomyoplasty patients and in experimental animal studies. The purpose of this study was to determine if heat shock could provide protection to skeletal muscle as has been shown in cardiac muscle. A 15-minute heat shock at 42°C resulted in an immediate increase in HSP72 mRNA and was followed within 3 hours by a two-fold increase in HSP72. Surgical dissection of the latissimus dorsi muscle (LDM) followed by an ischemic period resulted in a two-fold increase in HSP72 in control LDM, whereas the already high levels in the heat-shocked LDM increased only slightly with surgery and ischemia. Citrate synthase activity and tissue histology indicated that heat shock did not protect the LDM from the imposed surgical trauma and ischemic insults used in this study.     

Preservation of the Latissimus Dorsi Muscle During Cardiomyoplasty Surgery

A bstract Background : Cardiomyoplasty surgery has been shown to be associated with damage and degeneration of the assisting skeletal muscle. The purpose of this study was to use ischemic (short-term) and thermal (long-term) preconditioning to protect the muscle during surgery and the subsequent ischemia. Methods : Three 10-minute cycles of ischemia-reperfusion were accomplished noninvasively on goat latissimus dorsi muscle (LDM) immediately prior to surgery. In another experiment, LDM was noninvasively heat shocked for 20 minutes at 42°C 24 hours prior to surgery. LDM damage was evaluated 5 days postsurgery using enzyme activities (β-glucuronidase, β-GLN; citrate synthase), hydroxyproline, morphology, and blood flow. Results : The lysosomal enzyme, β-GLN, was significantly increased (43%, p < 0.05) by surgical dissection and remained high in the ischemic preconditioned LDM (58%, p < 0.05) and in the heat shocked LDM (57%, p < 0.05). Conclusion : These findings show that these two protective protocols do not reduce the muscle damage that occurs during surgical preparation of the LDM for cardiomyoplasty.     

Progressive Latissimus Dorsi Muscle Denervation for Free-Flap Dynamic Cardiomyoplasty

A bstract Background : The creation of free muscle grafts for surgical myoplasty is limited by the dependence of muscle on its original nerve supply. The aim of this study was to develop a model of gradual denervation of a large skeletal muscle (latissimus dorsi) and evaluate the possibility that atrophic degeneration and loss of function would be reduced using progressive nerve compression instead of surgical division of the nerve. The effects of chronic stimulation prior to, and after, denervation were also evaluated. Methods : Electrodes connected to a myostimulator were implanted on 24 latissimus dorsi muscles of 12 goats. Denervation of these muscles was achieved either by sectioning of the nerve or by progressive compression using ameroid rings placed around the nerve. Electrostimulation of the muscle started either 5 weeks before (prestimulation), or immediately after the denervation. Results : The model of gradual nerve compression was successfully created and did have less atrophy and loss of function at mid-term when compared with nerve division. Chronic electrostimulation of the muscle after nerve division had a beneficial effect on function and on the atrophic process. Chronic electrostimulation in our model of gradual nerve compression did not mirror these beneficial results. Detrimental results were observed in groups in which chronic electrostimulation was applied prior to nerve division or constriction.     

Optimal Electrical Stimulation for Latissimus Dorsi Muscle After Cardiomyoplasty

A bstract The aim of this study was to evaluate the functional state of latissimus dorsi muscle (LDM) during electrical stimulation following cardiomyoplasty. Both single pulses and bursts of impulses were used for electrical stimulation. In 15 dogs, studies were carried out for 2 months, while in 19 patients, the follow-up period after cardiomyoplasty was 10 ± 3.1 months. The LDM was punctured by needle electrodes at various intervals following cardiomyoplasty, and the changes of the rheomyosignal (RMS) curve were registered on the "Reostim-06." During the follow-up study, it was found that: (1) signal amplitude decreased 30%; (2) the contraction duration of LDM increased 38%; (3) the contraction velocity decreased 43%; and (4) relaxation velocity decreased 61%. There is a correlation between LDM mechanical contractile force and RMS indices (r = 0.8). The RMS index was a function of the electrical burst duration and the number of impulses in the bursts. Thus, RMS parameters can characterize the functional state of LDM, and they may be used in designing a new generation of electromyostimulators for optimal LDM stimulation at different periods after cardiomyoplasty.     

Blood Supply to the Latissimus Dorsi Muscle and Muscle Performance During Co- or Counterpulsatile Stimulation for Circulatory Assist

Abstract: For the application of the latissimus dorsi muscle (LDM) to circulatory assist, the muscle is stimulated with co- or counterpulsation during the cardiac cycle. The purpose of this study was to evaluate the blood supply to the LDM and its muscular performance during each respective stimulation. The origin of the LDM was connected to a tension gauge, a potentiometer, and 1 kg of weight in series. The LDM was stimulated at a ratio of 1:1 of heart to muscle contraction for 10 min. Copulsatile stimulation made thoracodorsal arterial flow (TDF) pre dominant during cardiac diastole. In counterpulsatile stimulation, TDF occurred predominantly during cardiac systole. Between the 2 patterns of stimulation, no significant differences were observed in the mean TDF rate during 1 cardiac cycle. The maximal force, maximal contrac tion length, and power of the LDM also did not differ significantly. These results suggest that despite the difference of the TDF profile, LDM performance may be com parable between co- and counterpulsatile stimulation for the application of the LDM to circulatory assist.     

Hot-Knife Dissection of the Latissimus Dorsi Muscle for Dynamic Cardiomyoplasty

Abstract: The overall purpose of circulatory assistance utilizing skeletal muscle is the most efficient application of muscle power. From the histological viewpoint, hot-knife dissection of the latissimus dorsi muscle (LDM) is presented to preserve muscle tissue. The shaw hemostatic scalpel could be used similarly to standard surgical blades, and its hemostatic performance was efficient in sealing collateral vessels from the thoracic wall. Muscular and nervous twitching was never observed throughout dissecting the LDM. Histological findings revealed that muscle fibers could be preserved by hot-knife dissection rather than by electrocautery. This technique may reduce the inconvenience of the operators, and, therefore, shorten the operation time in dynamic cardiomyoplasty and other experiments.     

Canine Latissimus Dorsi Muscle: An Apparatus for Isometric Force Measurements

Abstract: This paper describes a device used to measure the isometric forces generated during electrical stimulation of the canine latissimus dorsi muscle in vivo with a preserved neurovascular supply. This device uses 2 strain gauge force sensors linked to a movable alignment frame to which the muscle is attached. The muscle length is controlled by the application of known weights to the system. The device has a frequency of response of 17.5 Hz and compliance of -0.1 mm N^-1, and its experimental performance was tested in the anesthetized mongrel dog.     

Effects of Carnitine on Preconditioned Latissimus Dorsi Muscle at Different Burst Frequencies

A bstract Exercise and electrical stimulation may result in a decrease in carnitine levels associated with preconditioned latissimus dorsi muscles. Therefore, the effects of exogenous carnitine were studied in a model of latissimus dorsi muscle contraction. Twelve dogs were studied. Under anesthesia, the latissimus dorsi was placed around an implantable mock circulation system. The muscle was made fatigue-resistant with the aid of chronic low-frequency electrical stimulation. Six animals received carnitine 0.15 mmol/kg; the other six served as control. The muscles were stimulated with 20, 43, and 85 Hz pulse training. During the 90-minute stimulation period, the pressure that developed in the mock circulation was measured at 15 minute intervals. The changes in ATP and lactate levels were measured every 30 minutes. Stimulations at 20 and 43 Hz did not result in any change in pressure or metabolic data over the course of 90 minutes of stimulation. When the 85 Hz burst was applied, ATP levels decreased, while lactate levels increased, with an associated drop in pressure in the control group. ATP and lactate levels were, respectively, 13.8 ± 1.4 μmol/g and 15.0 ± 4.0 μmol/g in the carnitine group and 10.3 ± 1.1 μmol/g and 23.0 ± 3.0 μmol/g in the control group at the end of 90 minutes (p < 0.05). The pressure at the same time interval was 74 ± 4 mmHg in the control group, and 85 ± 3 mmHg in the carnitine group (p < 0.05). In this study, we demonstrated that carnitine administration enhances muscle performance in terms of metabolic and pressure changes during high-frequency electrical stimulation at 85 Hz.     

Delayed Breast Reconstruction with Latissimus Dorsi Flap

Background  The ideal method of breast reconstruction should be safe, reliable, and have minimal or no donor-site morbidity. We present our experience with the latissimus dorsi musculocutaneous flap for delayed breast reconstruction with immediate permanent implant insertion. Methods  The latissimus dorsi musculocutaneous flap was performed on patients who presented for delayed breast reconstruction. From 1999 to 2007, charts of patients were reviewed for age, type of mastectomy, history of chest wall irradiation, nipple-areola complex reconstruction, and complications at both the donor site and the reconstructed breast site. Results  The latissimus dorsi was used as a musculocutaneous flap in 33 patients who had breast cancer surgery. The mean age was 51.14 (range = 30–63) years. Nine patients (27%) asked for nipple-areola reconstruction. Three patients had major complications (9%), including infection, partial flap ischemia, and liponecrotic pseudocysts. Eight patients required revision. Seroma was the most common problem observed at the donor site. Conclusion  The latissimus dorsi flap provides adequate soft tissue with a reliable blood supply for the enhancement of missing tissue after mastectomy. It is a safe method for breast reconstruction and an excellent alternative flap for patients at high risk for abdominal flap complications.