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 crucialrole in breast reconstruction, particularly for post-mastectomypatients or those dealing with post-burn deformities.The pedicled LD emerges as a dependable option for restoringvolume and in inframammary fold reconstruction in post-burnpatients. Nevertheless, a comprehensive assessment of its potentiallong-term functional effects is imperative prior to optingfor the pedicled LD in breast reconstruction.Objective: This study aims to evaluate the functional outcomesand patient satisfaction in breast reconstruction usingthe (LD) flap versus the (MSLD) flap in post-burned patients.Methodology: In this Ambidirectional Cohort Study(Combined retrospective and prospective cohort study), weenrolled twenty-four female patients who already underwentcorrection of post burn breast deformities to address post-burnbreast deformities between 2020 and 2022. The included patientswere divided into two groups; group I: (14 patients) withtraditional latissimus dorsi LD flap, group II (10 patients): UnderwentMSLD flap. Patient satisfaction was assessed usingthe Breast Q questionnaire, we also used the Western OntarioShoulder Instability Index (WOSI) to evaluate shoulder functionscores, and the functional assessment involved both objectivemeasures, such as geometric measurements of shoulderrange of movement and radiological assessment of the acromion-humeral interval (AHI).Results: Concerning the Breast Q and WOSI results, therewas statistically significant greater satisfaction in the MSLDflap group. As regarding the deficit in the range of shouldermovement and the AHI measurements, no statistically significantdifferences were observed between both groups, however,the MSLD flap group exhibited superior results.Conclusion: For post-burn breast reconstruction, MSLDshould be preferred, especially for younger patients. If MSLDis impractical, traditional LD is an acceptable alternative butwith shoulder limitations lasting up to 6 months post-surgery.Preoperative imaging to identify abnormal AHI, thus, preventingshoulder impingement and initiating early postoperativeshoulder exercises would help to achieve better outcomes.

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