The use of muscle-sparing latissimus dorsi myocutaneous flap (MSLD) to minimize functional morbidity in patients with post burn breast deformities

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Background: The Latissimus dorsi (LD) flap plays a crucial role in breast reconstruction, particularly for post-mastectomy patients or those dealing with post-burn deformities. The pedicled LD emerges as a dependable option for restoring volume and in inframammary fold reconstruction in post-burn patients. Nevertheless, a comprehensive assessment of its potential long-term functional effects is imperative prior to opting for the pedicled LD in breast reconstruction.Methodology: In this Ambidirectional Cohort Study (Combined retrospective and prospective cohort study), we enrolled twenty-four female patients who already underwent correction of post burn breast deformities to address post-burn breast deformities between 2020 and 2022. The included patients were divided into two groups; group I: (14 patients) with traditional latissimus dorsi LD flap, group II (10 patients): underwent MSLD flap. Patient satisfaction was assessed using the Breast Q questionnaire, we also used the Western Ontario Shoulder Instability Index (WOSI) to evaluate shoulder function scores, and the functional assessment involved both objective measures, such as geometric measurements of shoulder range of movement and radiological assessment of the acromion-humeral interval (AHI).Results: Concerning the Breast Q and WOSI results, there was statistically significant greater satisfaction in the MSLD flap group. As regarding the deficit in the range of shoulder movement and the AHI measurements, no statistically significant differences were observed between both groups, however, the MSLD flap group exhibited superior results.Conclusion: For post-burn breast reconstruction, MSLD should be preferred, especially for younger patients. If MSLD is impractical, traditional LD is an acceptable alternative but with shoulder limitations lasting up to 6 months post-surgery. Preoperative imaging to identify abnormal AHI, thus, preventing shoulder impingement and initiating early postoperative shoulder exercises would help to achieve better outcomes.

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