It is important to note that both muscular reinnervation and incomplete/distal nerve transection may contribute to compromised results and/or persistent animation.4 Technical error can be prevented through segmental resection of the main thoracodorsal nerve trunk—proximal to the neurovascular hilus—using a dorsal approach to avoid injuring the latissimus dorsi muscle and any structures embedded within the scarred axillae. As recommend by Schroegendorfer et al., at least 4 cm of thoracodorsal nerve is resected to achieve permanent sufficient denervation.5 We routinely clip the proximal/distal ends to prevent nerve sprouting and/or aberrant regeneration from adjacent nerve fibers. As with other minimally invasive techniques, improved scarring, reduced pain, and earlier postoperative recovery can be expected following endoscopic thoracodorsal neurectomy for correction of latissimus dorsi–based contractile deformities.
The authors have no financial interest to declare in relation to the content of this article.
Michael V. DeFazio, M.D.
Troy A. Pittman, M.D.
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2. Kääriäinen M, Giordano S, Kauhanen S, et al. The significance of latissimus dorsi flap innervation in delayed breast reconstruction: A prospective randomized study-magnetic resonance imaging and histologic findings. Plast Reconstr Surg. 2011;128:637e–645e
3. Szychta P, Butterworth M, Dixon M, Kulkarni D, Stewart K, Raine C. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast. 2013;22:667–672
4. Paolini G, Longo B, Laporta R, Sorotos M, Amoroso M, Santanelli F. Permanent latissimus dorsi muscle denervation in breast reconstruction. Ann Plast Surg. 2013;71:639–642
5. Schroegendorfer KF, Hacker S, Nickl S, Vierhapper M, Nedomansky J, Haslik W. Latissimus dorsi breast reconstruction: How much nerve resection is necessary to prevent postoperative muscle twitching? Plast Reconstr Surg. 2014;134:1125–1129
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