Another option for reconstruction is a latissimus dorsi muscle free flap, which involves harvesting a muscle from one location and transferring it to another location. This is done by first harvesting the muscle from the donor site and then transferring it to the recipient site through microsurgical anastomosis. This procedure is usually done under general anesthesia because of the extensive nature of the surgery, although the donor and recipient sites can be located anywhere on the body and the muscle can be transferred under local anesthesia if desired.
A double-opposing latissimus muscle free flap has been described for reconstruction of the anterolateral aspect of the elbow. The donor is the latissimus dorsi muscle, which can be transferred to the lateral arm area. The recipient site is selected from the upper arm and lateral chest.
More recently, a double-opposing latissimus dorsi muscle free flap has been used. In this approach, two muscle flaps are harvested, one from the back and one from the front, and then transferred to anatomically opposed sites on the chest and back through microsurgical anastomosis. This is usually done under general anesthesia for larger defects. This procedure offers the advantage of using a single surgical incision for both the donor and recipient sites, which reduces the chance of adhesion formation and scarring.
The senior author regularly performs FFMT and muscle free flaps. He has performed over 30 FFMTs for patients with extremity defects. One of his most prominent cases involved a young woman who had undergone 10 previous surgeries and had been left with a large defect from a previous surgery. She had previously received a FFMT and a transfer of a vastus lateralis muscle and these had failed because the muscle had atrophied. Her second donor was a small, thin individual, but the muscle was too small for her. The senior author performed the latissimus dorsi muscle free flap to the back of the hand, on the same side as her previous donor, and with the use of his technology, the transferred muscle was large enough to provide function to her hand. His performance of this procedure, which required four microsurgical operations to perform, is available on his Freesurgeons.org Web site.
Standard radical mastectomy includes removal of the nipple, areola, and skin overlying the pectoralis major muscles. The pectoralis major muscle is extended and inset into the chest wall over the bone and fascia. This provides a sturdy framework to reconstruct the breast mound and provide support for a breast prosthesis.
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