COVID-19 Division, Wonju Public Health Center, Wonju 26417, Korea.
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
Toxins (Basel). 2022 Jan 30;14(2):107. doi: 10.3390/toxins14020107.
Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler's method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20-40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.
背阔肌皮瓣乳房再造术后的疼痛是一种常见现象。在手术中注射肉毒杆菌神经毒素（BoNT）可有效减轻术后疼痛。本研究旨在确定 BoNT 注射的最佳位置。在 16 个标本的背阔肌上进行了改良的 Sihler 法。在肱骨内侧手术颈的标志与穿过 T5 棘突和髂嵴中点的线之间，注意到肌内神经分支。背阔肌分为内侧、中间和外侧 3 个节段，有 10 个横切部分，共 10 个节段（每个 10%）。背阔肌的肌内神经分支最大的是从肌肉的内侧和外侧部分，范围从 40%到 60%，中间部分从 30%到 60%，内侧、中间和外侧部分从 70%到 90%。神经进入点位于从肱骨内侧手术颈的内侧和外侧部分，占肱骨内侧手术颈到穿过 T5 棘突到髂嵴中点的线的 20%到 40%。这些结果表明，应在特定区域向背阔肌内注射 BoNT。
