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OALib Journal期刊

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Latissimus Dorsi Mini-Flap as a Volume Replacement Technique after Partial Mastectomy for Breast Cancer in the Upper and Central Breast Quadrants: A Single Center Experience  [PDF]
Waleed Elnahas, Ashraf Khater, Mohamed Hamdy, Emadeldeen Hamed, Osama Eldamshety, Mohamed Hegazy
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.711066
Abstract: Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation; wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer; 30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm3 ± 59.57) cm3, while the mean flap volume was (218.27 cm3 ± 53.64 cm3). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.
Reconstrucción mamaria mediante el colgajo musculocutáneo del dorsal ancho
Colás,C.; Lozano,J. A.; Pelay,M. J.;
Anales del Sistema Sanitario de Navarra , 2005, DOI: 10.4321/S1137-66272005000400006
Abstract: in breast reconstruction we try to achieve the greatest possible symmetry with the contralateral breast, with the smallest number of interventions, the least possible sequel and the greatest safety. when we find poor cutaneous quality in the thorax we must use techniques that provide a well vascularised tissue of good quality, which we obtain at a certain distance instead of using the thorax tissues themselves. this article reviews the latissimus dorsi musculocutaneous flap, the technique of elevation, variations of the flap, and the advantages and drawbacks involved. this is a very safe and versatile technique, with few sequels in the donor area, with a relatively short surgery time and with good aesthetic results.
Latissimus dorsi volteado para reconstrucción de carcinoma basocelular gigante en un paciente anciano
Balaguer-Cambra,J.; Landin Jarillo,L.; Gillen Morales,I.;
Cirugía Plástica Ibero-Latinoamericana , 2009, DOI: 10.4321/S0376-78922009000100013
Abstract: basal cell carcinoma are well known as slow local growth cutaneous tumors that can enlarge through years in low socioeconomic and poor health assistance environments, as in the case that we present, with a 21 x 13 cm ulcerated lesion located over back midline. the latissimus dorsi muscle flap offers a reliable reconstruction in elderly patients avoiding the use of free flaps. this flap, because of its two different pedicles, can be used to reach defects in opposite directions.
BREAST RECONSTRUCTION AFTER MASTECTOMY FOR CANCER. THE TECHNIQUE OF LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP
Mihaela Pertea,S. Lunca
Jurnalul de Chirurgie , 2005,
Abstract: Breast conservation surgery is now widely accepted as the treatment of choice in breast cancer. The aim of immediate breast reconstruction is to improve well-being and quality of life for women undergoing mastectomy for breast cancer. Immediate breast reconstruction after mastectomy has increased over the past decade, following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. The use of latissimus dorsi musculocutaneous flap to replace the volume loss after major breast resection is an option where the tumour to breast volume ratio is large. The latissimus dorsi muscle flap is a simple and reliable technique for breast reconstruction and was first described in 1896. The latissimus dorsi flap is known to be a well-vascularized flap with minimal risk of fat necrosis. The main disadvantage of this procedure is a high rate of donor-site seroma. Comparing with other techniques of reconstruction, the technique of latissimus dorsi flap is simple and imply a few steps: marking the flap, raising the flap, anterior transposition of the flap, covering the defect and donor site closure. This procedure must be known by all surgeons (general, plastic and breast) involved in breast surgery. The aim of this article is to describe the technique of latissimus dorsi flap in breast reconstruction.
Main morphological characteristics of the vascular pedicle of latissimus dorsi muscle and their relevance in operative treatment
Ili？ Marko,Le？i？ Aleksandar,Bumba？irevi？ Marko
Srpski Arhiv za Celokupno Lekarstvo , 2010, DOI: 10.2298/sarh1008449i
Abstract: Introduction. Considering operative treatment of various pathological conditions and traumatic injuries of extremities latissimus dorsi flap presents the most frequently used flap in reconstructive surgery. Objective. The aim of this paper was to analyze anatomical characteristics of the vascular pedicle of the latissimus dorsi muscle followed by morphometric analyzes of vascular elements. Methods. This paper was carried out in cooperation with the Institute of Anatomy of the School of Medicine, University of Belgrade. The study was based on 40 cadaver dissections followed by anatomical and morphometric analyzes. The first analysis included the determination of thoracodorsal artery (TDA) origin and its lateral and terminal branches, and the second one the observation of artery path. Furthermore the same features were analyzed on the thoracodorsal vein. During morphometric analyzes artery and vein length and diameter were recorded. Results. Our results showed that TDA always contains one lateral branch, while three other lateral branches were inconstant. In most cases TDA terminated in two branches, upper and lower, with average distance of 3.4 cm from the muscle. The mean recorded pedicle length was 9.9 cm. The average inner diameter of TDA was 1.85 mm. In further analyses the average observed thoracodorsal vein length was 10.5 cm with mean diameter of 2.93 mm. The result showed that vein origin was usually represented with two branches. Conclusion. The thoracodorsal artery is a blood vessel of considerable length and diameter which represents a great advantage in reconstructive flap surgery.
The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature
Rifaat Mohammed,Amin Ayman,Bassiouny Mahmoud,Nabawi Ayman
Indian Journal of Plastic Surgery , 2008,
Abstract: Background: Autologous breast reconstruction using the extended latissimus dorsi flap has been infrequently reported. In the current study, the authors are reporting their own clinical experience with this method. A review of the literature is also discussed. Materials and Methods: Over a three year period, 14 patients underwent breast reconstruction using the extended latissimus dorsi (LD) flap. Patients with small to medium sized breasts were selected. The age of the patients ranged from 29 to 42 years with a follow-up period ranging from six to 18 months. The indications, flap-related complications and donor site morbidity and aesthetic results were evaluated. Results: The main indication to use the flap was dorsal donor site preference by patients. The remaining patients were either not suitable for a flap from the abdomen or wished to get pregnant and were offered the dorsal donor site. Neither total nor partial flap loss was recorded but donor site morbidity was mainly due to seroma, which was treated conservatively in all patients, except for one who required surgery. Another two patients suffered from wound breakdown and distal necrosis of the back flaps. Mild contour deformity was also noted on the back of all patients but caused no major concern. Indeed, the overall patient satisfaction was very high. Conclusion: The extended LD flap proved to be a good option for autologous breast reconstruction in selected patients. Patients should be warned of the potential for seroma and mild contour back deformity.
Pedicled unipolar latissimus dorsi flap for reconstruction of finger extensor
Mitsuhiko Takahashi,Naohito Hibino,Seiji Ishii,Tadashi Mitsuhashi,Tokio Kasai
- , 2017, DOI: 10.1080/23320885.2017.1310620
Abstract:
Latissimus dorsi volteado para reconstrucción de carcinoma basocelular gigante en un paciente anciano Latissimus dorsi turn over flap for giant basal cell carcinoma reconstruction in elderly patient
J. Balaguer-Cambra,L. Landin Jarillo,I. Gillen Morales
Cirugía Plástica Ibero-Latinoamericana , 2009,
Abstract: Los carcinomas basocelulares son tumores cutáneos de crecimiento lento aunque pueden llegar a tener un gran tama o a lo largo de los a os si el entorno socioeconómico y asistencial del paciente es pobre, como sucede en el caso que presentamos, en el que la lesión ulcerada en la línea media de la espalda llegó a medir 21 x 13 cm de diámetro. El colgajo de Latissimus Dorsi permite gracias a sus dos pedículos y a ser pivotado, una posibilidad reconstructiva en el caso de pacientes ancianos, evitando el uso de colgajos libres. Basal cell carcinoma are well known as slow local growth cutaneous tumors that can enlarge through years in low socioeconomic and poor health assistance environments, as in the case that we present, with a 21 x 13 cm ulcerated lesion located over back midline. The Latissimus Dorsi muscle flap offers a reliable reconstruction in elderly patients avoiding the use of free flaps. This flap, because of its two different pedicles, can be used to reach defects in opposite directions.
Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the “spiral” reconstruction technique
Shahram Nazerani,Mohammad Hosein Kalantar Motamedi,Mohammad Reza Keramati,Tara Nazerani
Strategies in Trauma and Limb Reconstruction , 2010, DOI: 10.1007/s11751-010-0090-z
Abstract: We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upper extremity defects via resurfacing and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue expander (TE) was inserted under the LD muscle to expand the flap in a longitudinal direction thereby forming a “long” flap rather than a “wide” one. After excising the circumferential lesion, the expanded “elongated” flap was wrapped spirally around the extremity to cover the defect; the donor site was closed as usual. The 5 patients we treated via LDMC flaps in a spiral fashion were free of complications, and all were satisfied with the outcome. All the flaps survived and the spiral reconstruction allowed for a tension-free donor site closure and near complete recipient coverage. This technique is indicated for large circumferential extremity skin defects and deformities. Application of expanded LDMC flaps in a spiral fashion can be used by the reconstructive surgeon to resurface large circumferential upper extremity lesions when indicated. The idea of a long and thinned expansion flap must be in a longitudinal direction and we need this long expanded and thin flap to “spiral” it around the extremity to cover a large defect. The “spiral” flap coverage introduced here for large circumferential extremity defects enables the surgeon to cover the defect with simultaneous donor site closure and good results.
Breast Reconstruction With Extended Latissimus Dorsi Flap and Silicone Implant
Milan Vi？nji？,Predrag Kova？evi？,Ljiljana Paunkovi？,Goran ？or？evi？
Acta Facultatis Medicae Naissensis , 2010,
Abstract: Breast carcinoma is the most common female malignancy. Mastectomy and breast reconstruction are indicated to treat the disease and to improve quality of life. The aim of this study was to compare the esthetic results of breast reconstruction with extended latissimus dorsi flap and implant for breast cancer with and without denervation of latissimus dorsi muscle. Our study was a retrospective review of prospectively collected data. Surgery was performed as primary reconstruction in 24 (75%) and secondary reconstruction in 8 patients (25%). All patients were consecutively divided in two equal groups (with 16 patients each) with latissimus dorsi muscle intact or denervated. Their average age was 46.2 years. Primary reconstruction was done for stages I and IIA, and secondary reconstruction one year after the completion of oncologic treatment. Postoperative follow-up was two years.Early complications (hematoma, infection) were not observed and dorsal seroma was observed in four women (12.5%). Partial flap necrosis was found in one case, but complete flap necrosis was not found. In six patients (18.7%), unacceptable scarring at the donor site required correction.Two years after reconstruction the patients assessed the procedure as very good or excellent. Excelent grade was often statisticaly significant in the group with innervated flap. Primary or secondary breast reconstruction should become an integral part of breast cancer treatment. Extended latissimus dorsi flap with implant is a safe and relatively simple reconstruction technique and should be preferred to other similar techniques. We suggest the reconstruction with innervated musle flap for better esthetic results.
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