Latissimus dorsi flap breast reconstruction

The latissimus dorsi musculocutaneous flap provides a readily available local source of well-vascularized muscle and fat that can be used in conjunction with tissue expanders and implants to reconstruct the breast after mastectomy in both an immediate and a delayed fashion. The procedure is straightforward, consistent, and well tolerated by patients. Donor-site morbidity is minimal and the aesthetic results can be outstanding. Use of this technique is recommended as a versatile and predictable method for breast reconstruction.     

Latissimus dorsi mini-flap: a technique for extending breast conservation

The latissimus dorsi (LD) flap was first used in patients for breast reconstruction in 1896. More recently it has been used to fill defects after quadrantectomy or very wide excision. We have developed a two stage procedure for excision of large breast cancers which would otherwise require mastectomy. The first stage is a wide excision of the cancer without removal of the overlying skin. Thirty patients with large localized operable breast cancer underwent wide local excision followed 5 to 10 days later in 25 patients who had clear histological margins by an axillary dissection with transfer of the LD muscle and overlying fat into the defect in the breast (mini-flap). The cosmetic outcome of these 25 patients who underwent mini-flap were compared with age matched patients having a standard wide local excision and axillary node clearance or mastectomy and immediate breast reconstruction. The volume of tissue excised in patients having their defects filled by LD mini-flap was significantly greater than those women undergoing standard wide excision, p<0.001. Compared with patients who had a mastectomy and immediate breast reconstruction, patients who had mini-flaps reported a better treated breast shape, p=0.04, a greater resemblance to the opposite breast, less self consciousness and less change in attitude of their spouse, p=0.03 and they were more likely to choose the same operation in future compared with patients having immediate whole breast reconstruction, p=0.02. Results as rated by patients in the mini-flap group were similar to those women treated by standard wide local excision. Only one patient in the mini-flap group felt sexually inhibited. When wide local excision and LD mini-flap is performed as a two stage procedure, it is an oncologically safe technique and extends breast conservation to women with larger tumours. The cosmetic outcomes appear better than those following the alternative of mastectomy and immediate breast reconstruction.     

应用背阔肌岛状肌皮瓣修复烧伤后乳房畸形

目的 介绍应用背阔肌岛状肌皮瓣修复前胸壁烧伤后所致乳房瘢痕挛缩畸形的临床效果.方法 应用扩张或未扩张的背阔肌岛状肌皮瓣修复烧伤后乳房瘢痕、部分缺损畸形,其中轻、中度烧伤后乳房缺失2例,采用背阔肌岛状肌皮瓣修复重度乳房缺失5例,采用扩张的背阔肌岛状肌皮瓣修复.结果 共治疗7例,术后肌皮瓣完全成活,乳房形态明显改善,无肌皮瓣坏死、背部伤口感染、裂开及肩部功能障碍等并发症发生.供区无明显后遗畸形及功能障碍.结论 背阔肌岛状肌皮瓣血运良好,操作简便易行,是修复烧伤乳房畸形的较好方法.     

Latissimus dorsi musculocutaneous flap with trilobed skin island for breast reconstruction

Summary The latissimus dorsi musculocutaneous flap provides generous amounts of skin and muscle for reconstruction of a breast after mastectomy. Correct analysis of the lack of tissue is necessary to enable a good reconstruction with regard to position and shape. Insufficient skin with undue soft tissue tension over a prosthesis is one cause for a less-than-optimal result. A latissimus dorsi musculocutaneous flap with a trilobed skin island gives the reconstructed breast a natural appearance without undue tension.     

Latissimus dorsi muscle flap and tissue expansion for breast reconstruction

BACKGROUND: After mastectomy for breast cancer, especially when combined with radiation, inadequate wall thickness and insufficient elasticity of the skin are problems frequently encountered in breast reconstruction. We describe a reconstruction method using a latissimus dorsi muscle flap, followed by expansion, that creates no additional scar. METHODS: This retrospective study included 30 patients who underwent this 4-surgery reconstruction: the muscle flap was raised and drawn through the mastectomy scar; the expander was inserted; expander replacement with the definitive prosthesis and concomitant symmetrization of the contralateral breast; finally, reconstruction of the nipple-areola complex. RESULTS: Only 1 failure, prosthesis extrusion, was observed. A surgeon scored the outcomes as above average for 26 women, who were satisfied. DISCUSSION: We noted an overall lower complication rate and a lower reconstruction-failure rate compared with reported results. This approach obtained better tissue quality; the flap provided better covering thickness and expansion, yielding a larger muscle-skin pocket. CONCLUSIONS: This reconstruction procedure seems reliable and extends the indications of skin expansion, with satisfactory results.     

Latissimus dorsi flap remains an excellent choice for breast reconstruction

Latissimus dorsi flap has been unfairly relegated to a second option in breast reconstruction. One hundred consecutive latissimus dorsi muscle flaps (LDMF) with tissue-expander reconstruction were studied, mean follow-up 34.5 months (range, 1-175), 50 immediate, 50 delayed. With attention to a few technical details, excellent esthetic, soft reconstructions were achieved. Complications included 1 partial flap loss; 2 patients required inframammary fold revision; and 6 patients required surgery for capsular contracture. Donor-site seroma occurred in 34 patients; 6 required operative revision. Results were similar in the immediate versus the delayed groups. LDMF remains an esthetic, reliable, safe reconstructive choice.     

Latissimus dorsi breast reconstruction utilizing functional muscle transfer and tissue expansion

Latissimus dorsi breast reconstruction with implants has been criticized for Baker III or IV capsular contractures in as many as 30% of patients. Also criticized is muscle atrophy and loss of breast volume and definition. This study evaluated 2 modifications of the classic latissimus reconstruction: muscle transferred as an innervated functional unit and tissue expansion posterior to the latissimus but anterior to the pectoralis muscle. After expansion, a permanent prosthesis was placed (46 silicone gel and 3 saline). Forty-nine such reconstructions were done in 32 patients (17 bilateral and 15 unilateral), with average follow-up of 19 months. Only 4 Baker III capsular contractures (8%) and no Baker IV contractures occurred. All patients demonstrated excellent retention of breast shape/definition. This study demonstrates that functional muscle transfer and tissue expansion results in low capsular contracture rates and excellent retained breast shape.     

Latissimus dorsi pedicled flap for upper extremity soft-tissue reconstruction

The latissimus dorsi often is used as a functional muscle transfer to restore elbow and shoulder motion. Although less common, its use as a pedicled muscle flap with a split-thickness skin graft provides excellent soft-tissue coverage of large upper extremity wounds. Seven male patients ranging in age from 6-71 years were treated with a pedicled latissimus dorsi muscle flap and split-thickness skin graft for coverage of open wounds of the shoulder, arm, or elbow with exposed vital structures (mean wound size: 15x10 cm). The flap also was used as a functional muscle transfer in one patient to replace destroyed anterior and middle portions of the deltoid. Wounds resulted from trauma in three patients, infection following trauma in two, and sarcoma excision in two. All flaps healed well, and donor site morbidity was minimal. At mean 16-month follow-up (range: 3-41 months), all muscle flaps had contoured well, producing satisfactory cosmesis. Functional results were good, and all patients were satisfied with their outcome. The tendinous insertion is left intact to guard against excessive traction on the pedicle when the flap is used for soft-tissue coverage only.     

Latissimus dorsi muscle flap for lower extremity reconstruction in children

Complete loss of free latissimus dorsi muscle flaps to the leg is frequently reported. The purpose of this study is to analyze the outcome of latissimus dorsi muscle flaps to the lower extremity in children. Patients and methods. This retrospective analysis includes 11 children treated with a free latissimus dorsi muscle flap after severe trauma to the lower leg and foot. Results. Fourteen free latissimus dorsi muscle flaps were performed in 11 children with a mean age of 13 ± 4 years. The injuries were caused by traffic accidents, lawnmower accidents, and a crush trauma. Thirteen (92.8%) flaps needed surgical revision. Three complete flap losses and 1 partial flap loss were registered. Conclusions. Free latissimus dorsi muscle flaps seem to be a useful technique for lower extremity salvage after severe injury, but there is a relevant flap failure risk in children. © 2010 Wiley‐Liss, Inc. Microsurgery 30:537–540, 2010.     

Latissimus dorsi flap harvest with a short incision

Latissimus dorsi (LD) flap is one of the most common options utilized in reconstructive armamentarium. In this report, we present our experience on harvest of the full LD muscle flap through a short incision. Twelve free and two pedicled full LD muscle flaps were raised in 14 patients (9 males and 5 females). In this technique, an oblique incision was placed 5–7 cm caudal to axillary apex, beginning from the posterior axillary line, so as to center the neurovascular hilus. The length of incision was 10 cm in adults and 8 cm in children. Mean dissection time was 45 min. All flaps survived totally. Seroma formation developed in two cases and treated with syringe aspiration and compressive dressing. In late postoperative period, donor site scars became inconspicuous and patient satisfaction was high. Short incision technique may be a good option to overcome scar problems in donor site of the LD flap. The technique reduces the dissection time and does not require sophisticated surgical devices and skill, when compared to endoscopic LD flap harvesting from the literature. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

Autologous breast reconstruction with latissimus dorsi flap

The gold standard technique for autologous breast reconstruction is the transverse rectus abdominis flap (TRAM). Recently, techniques of harvesting a latissimus dorsi flap have been modified in such a way as to increase the flap and allow breast reconstruction without an associated implant. The aim of this study was to evaluate aesthetic results obtained with this method and to assess early morbidity related to the changes in the technique. Between January 1994 and August 1998, 43 patients underwent breast reconstruction with an autologous latissimus dorsi flap. Their postoperative outcome was compared to that of 30 patients who underwent reconstruction with a latissimus dorsi flap associated with an implant. These 43 patients were asked to come back for aesthetic evaluation by a physician and to answer a questionnaire about cosmetic results. Mean duration of follow-up was 18.6 months (range 8 to 60). Mean size of the breast reconstructed with this technique was 340 g (up to 835 g). Dorsal seroma was the most frequent complication (72%), followed by delayed dorsal healing (19%). The frequency of seroma was significantly increased when compared to a classic latissimus dorsi flap (P = 0.003), but frequency of skin slough was not. The aesthetic result was considered satisfactory in 93% of the cases by the patient and 77% of the cases by the physician. In conclusion, the extended latissimus dorsi flap allows reconstruction of small and medium size breasts, with a good aesthetic result. This flap appears to be an interesting alternative to the TRAM flap for autologous reconstruction in selected patients.     

Latissimus dorsi flaps oriented on the lateral intercostal artery perforators: anatomical study and application in autologous breast reconstruction

Autologous breast reconstruction with the latissimus dorsi (LD) musculocutaneous flap has several problems including scarcity of tissue and postoperative atrophy of muscles. We report a modification of the flap based on a re-evaluation of the intramuscular and perforating vascular anatomy focused on the intercostal vascular system. Our anatomical study confirmed the following technical improvements: splitting of the muscle oriented along the 10(th) posterior intercostal artery; siting the axis of the flap on the centre of the 10(th) lateral intercostal artery perforator to obtain ample subcutaneous fat cranial to the iliac crest; and enclosing the dermoadipofascial flap around the split muscular pedicle. These flaps were used in 12 patients who required reconstruction without implants. The results showed a consistent volume of tissue and shape, and less donor site morbidity. Our modifications can be used to improve the three-dimensional potential of the LD flap in autologous breast reconstruction.     

The latissimus dorsi flap for breast reconstruction

The major factor limiting reconstruction of major postmastectomy deformities (especially after a radical mastectomy, such as that of Halsted) has been the lack of a satisfactory flap operation. The latissimus dorsal flap fills this need, as it allows a safe one-stage breast reconstruction, with an improved aesthetic result. It should be considered whenever insufficient chest wall skin remains for a satisfactory reconstruction. The author's technique for performing this flap operation is described, having evolved from cadaver dissections and eight clinical cases.     

Latissimus dorsi transfer for irreparable rotator cuff tears: a longitudinal study

Latissimus dorsi transfer is indicated for isolated posterior superior defects of the rotator cuff. Additional lesions limit the success of the outcome, but they are relatively frequent in revision surgery. We analyzed their influence on the postoperative function in 52 patients with an irreparable tear of the rotator cuff (35 primary operations, 17 revision surgeries). We observed a continuous improvement in the Constant score from 36 to 69 points, also in ROM, strength, relief of pain and of different subjective parameters for the entire group in consecutive examinations at 11.1, 35.7 and 50.2 months. We found increased osteoarthritis (from 1.0 to 1.5 mm), as well as a decrease in the acromiohumeral distance (from 5.6 to 4.7 mm). In contrast, we detected a slight decrease in the values in the revision group and in the presence of an additional subscapularis lesion.