Chicago, Ill.
From Northwestern Specialists in Plastic Surgery.
Plast Reconstr Surg. 2018 Mar;141(3):598-601. doi: 10.1097/PRS.0000000000004103.
The latissimus dorsi myocutaneous flap is a reliable and frequently used option to bring vascularized skin and soft tissue to improve the stability and aesthetic result in breast reconstruction. Standard techniques with skin paddle inset in a horizontal or oblique fashion preferentially improve anterior projection (when inset at the mastectomy scar) or lower pole and inframammary fold constriction (when inset into the inframammary fold). Here, the authors describe a modification for inset of the latissimus dorsi myocutaneous flap that improves both anterior projection and lower pole/inframammary fold constriction, and also allows the latissimus muscle to fan out and provide complete implant coverage. The vertical inset modification brings new skin and soft tissue into both the inferior pole and the central mastectomy scar, allowing simultaneous improvement in both areas and full use of the latissimus muscle to cover the implant or expander.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背阔肌肌皮瓣是一种可靠且常用的选择，可带来血管化的皮肤和软组织，以改善乳房重建的稳定性和美学效果。带有皮瓣的标准技术以水平或斜向方式插入，优先改善前突（当插入乳房切除术疤痕时）或下极和乳晕下皱襞收紧（当插入乳晕下皱襞时）。在这里，作者描述了一种改良的背阔肌肌皮瓣插入技术，可同时改善前突和下极/乳晕下皱襞收紧，并允许背阔肌展开，为植入物或扩张器提供完全覆盖。垂直插入改良术将新的皮肤和软组织带入下极和中央乳房切除术疤痕，可同时改善两个区域，并充分利用背阔肌覆盖植入物或扩张器。
临床问题/证据水平：治疗，IV。
