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Marchica P, Oieni S, David M, Coppola F, Rossi M, Cammarata E, Cordova A, Gebbia V, D'Arpa S. Latissimus Dorsi Flap and Thoracodorsal Artery Perforator Flap with Immediate Fat Transfer (LIFT and TIFT): A Retrospective Study about Total Breast Reconstruction in High-Risk Patients. Aesthetic Plast Surg 2024; 48:1745-1758. [PMID: 37580568 DOI: 10.1007/s00266-023-03528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Microsurgical breast reconstruction has become popular over the past twenty years and allows a tailor-tuck approach to each patient. However, smoking or coagulation disorders may switch surgeon's choice towards alternative options. When facing these risk factors, we performed pedicled latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap reconstruction with immediate fat transfer (LIFT and TIFT), achieving satisfactory surgical outcomes. Hence, we aim to present our seven-years case-series and discuss our decisional algorithm. MATERIALS AND METHODS Thirty smoker women and seven women affected by coagulation disorder (n = 37) respectively had LIFT and TIFT surgery and were retrospectively evaluated. Patients' demographics and outcomes were recorded and compared. RESULTS LIFT patients received higher volumes of immediate fat grafting compared to TIFT patients (p < 0.05), which required additional lipofilling to provide adequate volume amount, since the TDAP flap was not immediately grafted. However, the additional lipofilling procedures and fat volume were similar (p > 0.05). Flap survival reached 100%, and flap necrosis or loss did not occur. Few minor complications were evidenced in the LIFT group only (p > 0.05). CONCLUSION Based on our experience, we support the reliability of pedicled LD and TDAP flaps with immediate fat transfer in breast reconstruction as valuable alternative to microsurgery in smokers (LIFT) and patients with coagulation disorders (TIFT). However, the results of our study are not conclusive since still must be clarified the role of the smoking and coagulation disorders in microsurgery and the real benefit of a non-microsurgical procedure. LEVEL OF EVIDENCE IV Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Paolo Marchica
- Department of Plastic and Reconstructive Surgery, Treviso General Hospital, Piazzale dell'Ospedale, 1, 31100, Treviso, Italy.
| | - Sebastiano Oieni
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Massimo David
- Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Federico Coppola
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vittorio Gebbia
- Department of Medical Oncology, University of Enna "Kore", Enna, Italy
| | - Salvatore D'Arpa
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
- Residency School in Plastic and Reconstructive Surgery, International University of Goražde, Goražde, Bosnia and Herzegovina
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Longo B, D'Orsi G, Vanni G, Gagliano E, Buonomo CO, Cervelli V. Fat-Augmented Latissimus Dorsi Flap for Secondary Breast Reconstruction in Small to Medium-Sized Irradiated Breasts. Plast Reconstr Surg 2023; 152:1165-1173. [PMID: 36995214 DOI: 10.1097/prs.0000000000010480] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Secondary breast reconstruction (BR) is recognized as a challenging procedure, particularly when radiotherapy (RT) has previously been performed. The aim of this study was to compare operative data and aesthetic outcomes between secondary irradiated and immediate BR using the fat-augmented latissimus dorsi (FALD) flap. METHODS The authors conducted a prospective clinical study between September of 2020 and September of 2021. Patients were divided into two groups: group A included secondary BR using the FALD flap in previously irradiated breasts, and group B included immediate BR with the FALD flap. Demographics and surgical data were compared, and an aesthetic analysis was performed. Chi-square and t tests were performed for categorical and continuous variables, respectively. RESULTS Twenty cases of FALD flap-based BR for each group were included. The two groups were found to be homogeneous for the demographic variables. The difference in mean operative time (263.1 minutes versus 265.1 minutes; P = 0.467) and complications ( P = 0.633) between the two groups were not significant. There was statistically significant difference in term of immediate fat grafting volume in favor of group A (218.2 cc versus 133.0 cc; P < 0.0001). Regarding aesthetic outcomes, the mean global score evaluation showed no statistically significant differences between groups (17.86 versus 18.21; P = 0.209). CONCLUSIONS The authors' study states that the FALD flap can be considered a reliable procedure for secondary reconstruction in previously irradiated breasts, although it is not indicated for patients with larger breasts. This surgical technique allowed us to achieve a totally autologous BR with good aesthetic results and low complication rates, even in secondary irradiated cases. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Benedetto Longo
- From the Department of Surgical Sciences, School of Medicine and Surgery
| | - Gennaro D'Orsi
- Department of Surgical Sciences, School of Medicine and Surgery, PhD Program in Medical-Surgical Applied Sciences
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome
| | - Elettra Gagliano
- From the Department of Surgical Sciences, School of Medicine and Surgery
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome
| | - Valerio Cervelli
- From the Department of Surgical Sciences, School of Medicine and Surgery
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Volume Prediction of Extended Latissimus Dorsi Musculocutaneous Flap for Breast Reconstruction Using a Computed Tomography Volume-Rendering Technique with an X-ray Contrast Thread Marking. Aesthetic Plast Surg 2023:10.1007/s00266-023-03255-9. [PMID: 36695843 DOI: 10.1007/s00266-023-03255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The extended latissimus dorsi (ELD) musculocutaneous flap is one of the surgical techniques used for breast reconstruction. Preoperative preparation to determine the exact amount of flap tissue to be harvested is important to achieve a good outcome with autologous tissue reconstruction. However, few reports exist on objective preoperative volume prediction of ELD flaps. The purpose of this study was to quantify the elevated ELD volume as a preoperative plan. METHODS Patients who underwent immediate or delayed breast reconstruction with ELD flap after mastectomy between March 2015 and January 2022 are included. (1) The ELD flap was designed preoperatively, X-ray contrast thread was applied along the design, and CT imaging was performed in the same lateral supine position as the surgical position. 3D images were constructed, and the volume-rendering method was used to obtain the integrated volume. (2) Intraoperative ELD flap volume was calculated using the water displacement method. The correlation between (1) and (2) was examined. RESULTS (1) The mean preoperative predicted value was 290.2 mL and (2) the mean intraoperative ELD flap volume was 298.3 mL. The correlation coefficient between the two volumes was 0.93, indicating that they were correlated. CONCLUSION We could quantify the ELD flap volume using the volume-rendering method with X-ray contrast threads. This study could be a useful method for preoperative prediction planning of the ELD flap in breast reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Ouyang Y, Xu B, Luan J, Liu C. Chest Wall Reconstruction in Male Poland Syndrome Patients with Endoscopic-Assisted Latissimus Dorsi Muscle Flap Transfer. J Plast Reconstr Aesthet Surg 2021; 74:3141-3149. [PMID: 34039526 DOI: 10.1016/j.bjps.2021.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pectoralis major absence generates chest wall deformity and always requires surgical intervention. This study aimed to introduce a technique to reconstruct the chest wall for male Poland Syndrome patients with endoscopic latissimus dorsi muscle (ELDM) flap via a single transverse axillary incision and evaluate its safety and effectiveness. METHODS A prospective study was designed to recruit male Poland Syndrome candidates for ELDM chest reconstruction. By performing a short and hidden transaxillary incision, we created anterior chest wall pocket and transferred the latissimus dorsi muscle (LDM) flap to recontour the chest wall. Data for patient demographics, LDM flap dimension, operative time, and complications were collected. Upper extremity functional disabilities were evaluated by the disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Satisfaction with the outcome was measured by satisfaction with outcome subscale of the BREAST-Q questionnaire. RESULTS This study recruited 11 eligible patients to receive ELDM chest wall reconstruction. ELDM flap harvesting averagely consumed 79.9 minutes. Without significant complications, all patients recovered uneventfully. Chest wall anomalies of different severity were corrected safely and effectively. The score of DASH was 3.7±3.3 preoperatively and 4.0±3.7 postoperatively with no statistically significant difference. The score of satisfaction with the outcome was 84.8±14.3. CONCLUSIONS For chest wall anomalies of different severity in male Poland Syndrome patients, the ELDM technique provides a safe and efficient way to reconstruct the chest wall with a better aesthetic outcome, high satisfaction rate, and satisfactory upper limb function.
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Affiliation(s)
- Yiye Ouyang
- Plastic Surgery Hospital(Institute), Chinese Academy of Medical Sciences, Peking Union Medical College; Beijing, China
| | - Boyang Xu
- Plastic Surgery Hospital(Institute), Chinese Academy of Medical Sciences, Peking Union Medical College; Beijing, China
| | - Jie Luan
- Plastic Surgery Hospital(Institute), Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Chunjun Liu
- Plastic Surgery Hospital(Institute), Chinese Academy of Medical Sciences, Peking Union Medical College; Beijing, China.
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Tenna S, Salzillo R, Brunetti B, Morelli Coppola M, Barone M, Cagli B, Cogliandro A, Franceschi F, Persichetti P. Effects of latissimus dorsi (LD) flap harvest on shoulder function in delayed breast reconstruction. A long-term analysis considering the acromiohumeral interval (AHI), the WOSI, and BREAST-Q questionnaires. J Plast Reconstr Aesthet Surg 2020; 73:1862-1870. [PMID: 32586755 DOI: 10.1016/j.bjps.2020.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/10/2020] [Accepted: 05/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The latissimus dorsi (LD) flap is reliable and versatile with many indications and low donor site morbidity. The aim of this study is to evaluate the long-term effects of LD flap on the shoulder function in patients undergoing delayed breast reconstruction. METHODS This case-control study enrolled women who underwent implant-based (IB) breast reconstruction, radical lymphadenectomy, and radiotherapy between 2006 and 2016. The study group included 72 women, with a history of severe capsular contracture, who received a secondary LD flap reconstruction. The control group consisted of a matched cohort of 80 patients with IB breast reconstruction. Shoulder function was assessed using the acromiohumeral interval (AHI) measurement in standard X-rays. The validated Western Ontario Shoulder Instability (WOSI) and BREAST-Q questionnaires were used to assess outcomes one year postoperatively and data were analyzed using Fisher's exact test and the Mann-Whitney test. RESULTS Out of 72 patients from the study group, 40 had valuable pre- and postoperative X-rays to measure the AHI. An AHI reduction was recorded only in 7/40 patients. From the WOSI analysis, no significant differences in shoulder function and back pain between the two groups were registered. BREAST-Q scores in the LD group were higher in most domains, including satisfaction with breasts and psychosocial well-being. However, the Mann-Whitney test showed no significant difference between the two groups (p > 0.05). CONCLUSION LD flap, with detachment of its insertions from the humerus, does not seem to have a negative impact on back and shoulder function and is correlated with high patient satisfaction in breast reconstruction following radiotherapy.
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Affiliation(s)
- Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy).
| | - Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Mauro Barone
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Francesco Franceschi
- Department of Upper and Lower Limb Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Rome, (Italy)
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Identifying Preoperative Factors Associated with the Volume Discrepancy in Patients Undergoing Breast Reconstruction with the Extended Latissimus Dorsi Musculocutaneous Flap Coverage. Aesthetic Plast Surg 2019; 43:1490-1496. [PMID: 31218382 DOI: 10.1007/s00266-019-01417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The latissimus dorsi (LD) flap is a versatile option for breast reconstruction. However, the indications are limited because of volume discrepancy between the breast and the flap. We conducted this study to identify preoperative factors associated with the volume discrepancy in patients undergoing breast reconstruction with the extended LD flap. METHODS A retrospective study was performed in 69 patients (69 breasts) who underwent breast reconstruction with the extended LD flap between March 2015 and March 2018. We evaluated age, body weight, height, preoperative body mass index (BMI), postoperative BMI, breast skin defect size, breast volume, flap volume, and volume discrepancy [breast volume - flap volume]. RESULTS Mean age, height, body weight, preoperative BMI, postoperative BMI, skin defect size, breast volume, flap volume, and volume discrepancy were 45.6 ± 7.1, 157.8 ± 0.1, 59 ± 8.1, 23.7 ± 3.2, 23.5 ± 3.3, 16.5 ± 9.3, 252.2 ± 107.1, 229.4 ± 95.6, and 32.6 ± 31.4, respectively. Spearman's rank correlation coefficients indicated significant positive linear correlations between volume discrepancy and preoperative BMI (correlation coefficient = 0.267, P = 0.027), volume discrepancy and breast volume (correlation coefficient = 0.472, P < 0.001), and between volume discrepancy and skin defect size (correlation coefficient = 0.609, P < 0.001). Stepwise multiple regression analysis yielded the following formula: predicted log volume discrepancy (ml) = 1.2891 + 0.0639 × skin defect size + 0.0025 × breast volume (R2 = 0.421). CONCLUSION Skin defect size and breast volume were preoperative factors associated with volume discrepancy in patients who have undergone breast reconstruction with the extended LD flap. Considering these factors, we can predict the lack of volume and plan any necessary secondary procedures. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Liu C, Luan J, Ouyang Y, Zhuang Y, Xu B, Chen L, Li S, Fu S, Xin M. Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision. Aesthetic Plast Surg 2019; 43:1186-1194. [PMID: 30877446 DOI: 10.1007/s00266-019-01346-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness. METHODS A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. RESULTS Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0. CONCLUSIONS Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Hui T, Li F, Wu Y, Liu J, Ma Y, Rui Y. [Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1572-1575. [PMID: 30574716 PMCID: PMC8414234 DOI: 10.7507/1002-1892.201805042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/03/2018] [Indexed: 11/03/2022]
Abstract
Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.
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Affiliation(s)
- Taotao Hui
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China
| | - Fengfeng Li
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China
| | - Yongwei Wu
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China
| | - Jun Liu
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China
| | - Yunhong Ma
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P.R.China
| | - Yongjun Rui
- Department of Orthopedics and Trauma, the Wuxi Ninth Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062,
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Wang Y, Ren Z, Xue J, Guo L, Gao D, Hao Q, Gao F, Yang J. [Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1187-1191. [PMID: 30129330 PMCID: PMC8413978 DOI: 10.7507/1002-1892.201803046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/18/2018] [Indexed: 11/03/2022]
Abstract
Objective To investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer. Methods Between January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly. Results All the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites. Conclusion The latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.
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Affiliation(s)
- Yaojun Wang
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000,
| | - Zhongliang Ren
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Jiajie Xue
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Lei Guo
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Dengwen Gao
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Qingye Hao
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Fucheng Gao
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
| | - Jie Yang
- Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City , Yulin Shaanxi, 719000, P.R.China
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Vertical Inset of the Latissimus Dorsi Flap Improves Reconstruction Aesthetics by Reducing Scar Burden in the "Social Breast". Ann Plast Surg 2018; 80:S365-S371. [PMID: 29847374 DOI: 10.1097/sap.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The skin paddle of the latissimus dorsi flap is typically inset horizontally (HILD) in breast reconstruction. We describe our experience with the vertical inset of the latissimus dorsi (VILD) and its aesthetic benefit. METHODS We performed a case-control study comparing the most recent cases of both VILD and HILD. Scar, as seen on anterior-posterior photographs, was digitally measured and compared from 3 clinically relevant areas: (1) all visible scarring ("mirror view"), (2) scarring above the nipple ("self-view"), and (3) scarring above or medial to the nipple ("social view"). Demographics and outcomes were statistically compared. EXPERIENCE/RESULTS Fifty of the most recent patients receiving HILD or VILD were selected for each group. Average patient age was 55.6 and 51.6 years (P = 0.32), and average follow-up was 531.6 and 606.7 days (P = 0.20), respectively. The VILD scar-length ratios were decreased by 17% in the mirror view (P ≤ 0.01), 37% in the self-view (P ≤ 0.01), and 37% in the social view (P ≤ 0.01). There were no statistically significant differences between groups regarding smoking (P = 0.75), diabetes (P = 0.70), body mass index (P = 0.74), seroma (P = 0.46), infection (P = 1.0), or flap necrosis (P = 0.70). CONCLUSIONS The VILD is safe and reliable. Measurements from anterior-posterior photographs illustrate statistically significant decreases in overall scar burden (mirror view) and statistically significant reductions in the highly visible self-view and social view. Our study is the first to quantify a reduction in scar burden by using VILD technique.
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Liu Z, Tang X, Wang D, Wei Z, Jin W, Deng C, Qi J. [Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1106-1110. [PMID: 29798570 PMCID: PMC8458423 DOI: 10.7507/1002-1892.201704047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/18/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S 1 in 2 cases, S 2 in 6 cases, S 3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
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Affiliation(s)
- Zhiyuan Liu
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Xiujun Tang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003,
| | - Dali Wang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Zairong Wei
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Wenhu Jin
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Chengliang Deng
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Jianping Qi
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
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Comparison of Donor Site Drainage Duration and Seroma Rate Between Latissimus Dorsi Musculocutaneous Flaps and Thoracodorsal Artery Perforator Flaps. Ann Plast Surg 2017. [DOI: 10.1097/sap.0000000000001077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhu L, Mohan AT, Vijayasekaran A, Hou C, Sur YJ, Morsy M, Saint-Cyr M. Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting. Aesthet Surg J 2016; 36:169-78. [PMID: 26546990 DOI: 10.1093/asj/sjv173] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume. OBJECTIVES The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction. METHODS A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer. RESULTS Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting. CONCLUSIONS The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Lin Zhu
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Anita T Mohan
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Aparna Vijayasekaran
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Christine Hou
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Yoo Joon Sur
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Mohamed Morsy
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Michel Saint-Cyr
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
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Yang Y, Chen Y, Qu J, Zhang X, Pan Y. The use of OK-432 to prevent seroma in extended latissimus dorsi flap donor site after breast reconstruction. J Surg Res 2015; 193:492-6. [DOI: 10.1016/j.jss.2014.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/17/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
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Kääriäinen M, Giordano S, Kauhanen S, Helminen M, Kuokkanen H. No need to cut the nerve in LD reconstruction to avoid jumping of the breast: A prospective randomized study. J Plast Reconstr Aesthet Surg 2014; 67:1106-10. [DOI: 10.1016/j.bjps.2014.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/14/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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