title: Latissimus dorsi breast reconstruction: how much nerve resection is necessary to prevent postoperative muscle twitching?
abstract: BACKGROUND
  The latissimus dorsi muscle flap represents a valuable option in breast reconstruction but can result in postoperative twitching and retraction, discomfort, arm movement limitations, and breast deformation. These complications can be avoided by denervation of the thoracodorsal nerve; however, the optimal method of nerve management is unknown. This study presents the authors' experience with the outcomes of latissimus dorsi flaps for breast reconstruction in the light of thoracodorsal nerve management strategies.
  
  
  METHODS
  The authors retrospectively collected data from 74 patients who underwent partial or total breast reconstruction with a latissimus dorsi flap alone or with an implant between January of 1999 and October of 2011. Follow-up data were collected at 12 and 24 months postoperatively.
  
  
  RESULTS
  In 56 patients (75.7 percent), the latissimus dorsi muscle was denervated at the time of surgery, whereas the thoracodorsal nerve remained intact in 18 patients (24.3 percent). No partial or total flap loss was observed. At 12 and 24 months' follow-up, all patients with an intact thoracodorsal nerve showed twitching of the muscle, and 50 percent and 67.9 percent, respectively, of the denervated patients showed twitching (p < 0.001). No patient had twitching if more than 4 cm of nerve was excised at 12 or 24 months postoperatively, and the length of nerve resection was predictive of the presence of twitching.
  
  
  CONCLUSIONS
  Denervation of the latissimus dorsi is a safe and reliable procedure that should be performed at the time of breast reconstruction and should include more than 4 cm to achieve a nontwitching breast with a stable volume and shape.
authors.affiliation: Vienna, Austria From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Schroegendorfer
authors.forename: Stefan
authors.initials: S
authors.lastname: Hacker
authors.forename: Stefanie
authors.initials: S
authors.lastname: Nickl
authors.forename: Martin
authors.initials: M
authors.lastname: Vierhapper
authors.forename: Jakob
authors.initials: J
authors.lastname: Nedomansky
authors.forename: Werner
authors.initials: W
authors.lastname: Haslik
mesh_terms: D000328:Adult; D003714:Denervation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation / Q000637:transplantation*; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009135:Muscular Diseases / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000294:innervation / Q000637:transplantation*; D013900:Thoracic Nerves / Q000601:surgery*; D016896:Treatment Outcome