A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition

Our plain-English summary of A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition, by M.K. Widmer, T. Krueger, D. Lardinois, et al (European Journal of Cardio-thoracic Surgery, 2000).

The study

• Authors: M.K. Widmer, T. Krueger, D. Lardinois, A. Banic, H.B. Ris
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2000;18(4):435-9
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Comparison of intrathoracic latissimus dorsi (LD) versus serratus anterior (SA) muscle transposition for treatment of infected spaces, broncho-pleural fistulae, and for prophylactic reinforcement of the mediastinum after extended resections following induction therapy.

Patients And Methods: Twenty LD and 17 SA transfers were performed for prophylactic reinforcement (11 LD; nine SA), and treatment of infections (nine LD; eight SA) from 1995 to 1998.

Results: The 30-day mortality was 0% following prophylactic reinforcement and 29% following treatment of infections (three LD; two SA). Prophylactic mediastinal reinforcement was successful in 11 of 11 patients with LD and nine of nine with SA transpositions, and treatment of infected spaces in eight of nine patients with LD and two of three with SA transfers. Morbidity requiring re-intervention consisted of flap necrosis (one LD), bleeding (one SA), and skin necrosis over a winged scapula (one SA). Subcutaneous seromas and chest wall complaints were more frequent following LD (45 and 36%, respectively) compared with SA transfers (29 and 27%, respectively), whereas impaired shoulder girdle function was more frequent after SA than after LD transfer (27 vs. 21%).

Conclusion: Intrathoracic LD and SA muscle transpositions are both efficient for the prevention or control of infections following complex thoracic surgery, and are both associated with similar and acceptable morbidity and long-term sequelae.

In plain English

This study compared two ways of moving a chest-wall muscle into the chest cavity: latissimus dorsi (LD) and serratus anterior (SA) transfer. The authors' institution followed patients prospectively from November 1995 to December 1998. In that time, 37 patients had LD or SA transfers. Some transfers reinforced the mediastinum after major cancer surgery, including extrapleural pneumonectomy for malignant mesothelioma. Others treated chest infections. SA was used when the LD had been divided at an earlier operation. The 30-day death rate for the whole series was 14%, and all deaths followed transfers for infection. Preventive reinforcement was successful in 11 of 11 LD and nine of nine SA patients. Infected spaces were controlled in eight of nine LD patients and healed in two of three SA patients. Three patients (8%) needed re-operation. Among 25 patients seen at 6 months, shoulder function was normal in 11 of 14 after LD and 8 of 11 after SA. No statistically significant differences in long-term effects were found. The authors concluded that both transfers were efficient, with similar, acceptable morbidity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospectively followed series of all patients receiving the two types of muscle transfer at one institution (comparative surgical case series)
• Who was studied: 37 patients who had 38 intrathoracic muscle transfers, November 1995 to December 1998. The abstract counts 20 LD transfers (11 for preventive reinforcement, 9 for infections) and 17 SA transfers (9 preventive, 8 for infections). Preventive indications included extrapleural pneumonectomy for malignant mesothelioma followed by radio-chemotherapy and carinal reconstruction after induction therapy for non-small cell lung cancer. The number of mesothelioma patients is not reported separately.
• Exposure: Surgical procedure: intrathoracic transfer of the latissimus dorsi muscle versus the serratus anterior muscle. SA was used when the LD had been divided at a previous thoracotomy. Asbestos exposure was not assessed.
• Main results:
  • 30-day mortality for the entire series was 14% (five of 37 patients).
  • All 30-day deaths occurred after muscle transfer for infections; none occurred after preventive reinforcement.
  • Preventive mediastinal reinforcement was successful in 11 of 11 LD patients and nine of nine SA patients.
  • Infected postresectional spaces were controlled in eight of nine LD patients.
  • Two of three SA patients treated for postresectional space infection or destroyed lung healed uneventfully.
  • Three patients (8%) needed re-operation for complications related to the muscle transfer.
  • A seroma requiring drainage for more than 15 days occurred in 45% of LD patients and 29% of SA patients.
  • At 6 months, 22 of 25 patients had a normal quality of life without restriction in daily activities (13 of 14 LD, 9 of 11 SA).
  • At 6 months, chest wall complaints were found in eight of 25 patients (5 of 14 LD, 3 of 11 SA).
  • At 6 months, shoulder girdle function was normal and symmetrical in 19 of 25 patients (11 of 14 LD, 8 of 11 SA). Impaired shoulder girdle function was found in 27% after SA and 21% after LD transfer.
  • No statistically significant differences in long-term sequelae were found between SA and LD patients.
• The authors' conclusion: The authors concluded that LD and SA transfers are both efficient in preventing or controlling difficult intrathoracic infections, with similar postoperative morbidity and long-term sequelae and acceptable functional outcome and quality of life.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Mediastinum, Necrosis, Thoracic Surgery.

Related studies

• The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients — M. Beshay, G. Carboni, et al. (2008)
• The serratus anterior muscle on chest radiographs — D. Gilmartin (1979)
• Asbestosis and the serratus anterior muscle — J.D. Collins, R.K. Brown, et al. (1983)
• Diagnostic use of muscle markers in the cytologic evaluation of serous fluids — A.M. Afify, B.M. Al-Khafaji, et al. (2002)
• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Multiple skeletal muscle metastases from malignant pleural mesothelioma — W. Grellner, M. Staak (1995)

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