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Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk
Reconstruction of posterior cervical trunk defects secondary to tumor resection carries significant morbidity when vertebral hardware or the spinal cord is exposed, and neck extension is interrupted. Complete reconstruction includes the coverage and obliteration of dead spaces, but functional outcom...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647893/ https://www.ncbi.nlm.nih.gov/pubmed/34881143 http://dx.doi.org/10.1097/GOX.0000000000003567 |
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author | Lasso, Jose M. |
author_facet | Lasso, Jose M. |
author_sort | Lasso, Jose M. |
collection | PubMed |
description | Reconstruction of posterior cervical trunk defects secondary to tumor resection carries significant morbidity when vertebral hardware or the spinal cord is exposed, and neck extension is interrupted. Complete reconstruction includes the coverage and obliteration of dead spaces, but functional outcomes are necessary to prevent the head dropping. This report documents the first known technique, using a free latissimus dorsi neurovascular flap to provide neck extension after ablative oncological surgery affecting trapezium and paraspinal muscles of the neck. The author explains the method by using a branch of the accessory nerve as the donor nerve. While keeping the head in a neutral position, the tendinous part of the neurovascular flap was firmly attached to the occipital periosteum and to the cephalad remnants of the trapezius, splenius capitis, and semispinalis muscles. At the caudal portion of the defect, cardinal notches were used to set the muscle at rest, avoiding excessive fiber tension. The maximal length of the muscle at rest was measured before flap elevation, calculated via the anatomical 3D print model. The thoracodorsal nerve was stimulated until the muscle shortened its length to 50%. Head extension was tested several times via neurostimulation and electromyographic control. The described procedure may provide neck extension and circumvent the problem with donor nerve providing synergy to the desired function. |
format | Online Article Text |
id | pubmed-8647893 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-86478932021-12-07 Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk Lasso, Jose M. Plast Reconstr Surg Glob Open Reconstructive Reconstruction of posterior cervical trunk defects secondary to tumor resection carries significant morbidity when vertebral hardware or the spinal cord is exposed, and neck extension is interrupted. Complete reconstruction includes the coverage and obliteration of dead spaces, but functional outcomes are necessary to prevent the head dropping. This report documents the first known technique, using a free latissimus dorsi neurovascular flap to provide neck extension after ablative oncological surgery affecting trapezium and paraspinal muscles of the neck. The author explains the method by using a branch of the accessory nerve as the donor nerve. While keeping the head in a neutral position, the tendinous part of the neurovascular flap was firmly attached to the occipital periosteum and to the cephalad remnants of the trapezius, splenius capitis, and semispinalis muscles. At the caudal portion of the defect, cardinal notches were used to set the muscle at rest, avoiding excessive fiber tension. The maximal length of the muscle at rest was measured before flap elevation, calculated via the anatomical 3D print model. The thoracodorsal nerve was stimulated until the muscle shortened its length to 50%. Head extension was tested several times via neurostimulation and electromyographic control. The described procedure may provide neck extension and circumvent the problem with donor nerve providing synergy to the desired function. Lippincott Williams & Wilkins 2021-05-13 /pmc/articles/PMC8647893/ /pubmed/34881143 http://dx.doi.org/10.1097/GOX.0000000000003567 Text en Copyright © 2021 The Author. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Reconstructive Lasso, Jose M. Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title | Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title_full | Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title_fullStr | Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title_full_unstemmed | Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title_short | Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk |
title_sort | restoration of neck extension after severe oncological surgery of the posterior cervical trunk |
topic | Reconstructive |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647893/ https://www.ncbi.nlm.nih.gov/pubmed/34881143 http://dx.doi.org/10.1097/GOX.0000000000003567 |
work_keys_str_mv | AT lassojosem restorationofneckextensionaftersevereoncologicalsurgeryoftheposteriorcervicaltrunk |