Mojallal A, Saint-Cyr M, Wong C, Veber M, Braye F, Rohrich R
Service de chirurgie plastique réparatrice et esthétique, hôpital Edouard-Herriot, 5, place Arsonval, 69437 Lyon cedex 03, France.
Ann Chir Plast Esthet. 2010 Apr;55(2):87-96. doi: 10.1016/j.anplas.2009.04.004. Epub 2009 Aug 13.
The muscle-sparing latissimus dorsi flap pedicled on descending branch presents distinct advantages in breast reconstruction, specially when there is a transversely oriented skin paddle, including reduced donor site morbidity, sparing muscle function and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, advantages and complications of this technique. Four clinical cases illustrate surgical indications in breast reconstructive surgery.
An anatomical cadaveric study underwent to University of Texas Southwestern Medical Center, Dallas. The goal was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch compare to the anterior side of latissimus dorsi muscle. Four clinical cases illustrated indications of muscle-sparing latissimus dorsi flap pedicled on descending branch in breast reconstruction. These cases showed advantages and complications of the technique, and impact on donor site.
Fifteen descending branch muscle-sparing latissimus dorsi flaps were harvested. All flaps had a bifurcation of the thoracodorsal artery. The average was located at 5,1cm from posterior axillary side (from 2,1 to 7,5 cm) and average of 2,2 cm from the anterior side of latissimus dorsi muscle (from 1,3 to 3,1cm). To 5, 10 and 15 cm from posterior axillary side, the descending branch was located at respectively an average of 2,0 cm (from 1,4 to 2,5), 2,4 cm (from 1,3 to 3,3), and 2,9 cm (from 2,0 to 3,8) behind the anterior side of latissimus dorsi muscle. The average length of descending branch was measured at 15,2 cm (from 13,2 to 19,0). None clinical cases paddle suffering was observed. Donor site morbidity was less than classical or extended adipomuscular technique. Latissimus dorsi muscle function is spared.
The muscle-sparing latissimus dorsi flap, pedicled on descending branch, is versatile and reproducible. It results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar. There are a lot of indications in breast reconstruction.
以降支为蒂的保留肌肉的背阔肌皮瓣在乳房重建中具有明显优势，特别是当有横向的皮瓣时，包括供区并发症减少、保留肌肉功能以及皮瓣定向的更大自由度。本研究报告了该技术的解剖学基础、手术技术、优势和并发症。4例临床病例说明了乳房重建手术中的手术指征。
在达拉斯的德克萨斯大学西南医学中心进行了一项解剖学尸体研究。目的是确定胸背动脉分叉的位置及其降支与背阔肌前侧相比的走行。4例临床病例说明了以降支为蒂的保留肌肉的背阔肌皮瓣在乳房重建中的指征。这些病例显示了该技术的优势和并发症，以及对供区的影响。
共切取15个以降支为蒂的保留肌肉的背阔肌皮瓣。所有皮瓣均有胸背动脉分叉。平均位于距腋后线5.1cm（2.1至7.5cm），距背阔肌前侧平均2.2cm（1.3至3.1cm）。在距腋后线5cm、10cm和15cm处，降支分别位于背阔肌前侧后方平均2.0cm（1.4至2.5cm）、2.4cm（1.3至3.3cm）和2.9cm（2.0至3.8cm）处。降支平均长度为15.2cm（13.2至19.0cm）。未观察到临床病例皮瓣出现问题。供区并发症少于经典或扩大的脂肪肌肉技术。背阔肌功能得以保留。
以降支为蒂的保留肌肉的背阔肌皮瓣用途广泛且可重复。它导致供区功能缺陷最小、无血清肿、皮瓣定向自由度大、皮瓣并发症发生率低以及有美容可接受的瘢痕。在乳房重建中有很多指征。
