The Use of Muscle-Sparing Latissimus Dorsi Myocutaneous Flap (MSLD) to Minimize Functional Morbidity in Patients with Post Burn Breast Deformities

Ali, Rama; Hemidan, Ahmed Gamal; Gamal El Din, Dina H; Shehta, Nancy; Noaman, Ayman

doi:10.21608/ejprs.2025.405211

The Use of Muscle-Sparing Latissimus Dorsi Myocutaneous Flap (MSLD) to Minimize Functional Morbidity in Patients with Post Burn Breast Deformities

Document Type : Original Article

Authors

¹ The Department of Plastic Surgery, Faculty of Medicine, Cairo University

² Department of Plastic Surgery, Zayed Hospital, Cairo, Egypt

³ Department of Physiotherapy, Faculty of Medicine, Cairo University

10.21608/ejprs.2025.405211

Abstract

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.
Objective: This study aims to evaluate the functional outcomes
and patient satisfaction in breast reconstruction using
the (LD) flap versus the (MSLD) flap in post-burned patients.
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.

Keywords

Main Subjects

Burns

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