Johns N, Fairbairn N, Trail M, Ewing A, Yong L, Raine C, Dixon J M
Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
J Plast Reconstr Aesthet Surg. 2018 Feb;71(2):201-208. doi: 10.1016/j.bjps.2017.10.015. Epub 2017 Nov 24.
The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we report our experience of using the immediately lipofilled extended latissimus dorsi (ELD) flap and show it as a valid option for autologous breast reconstruction.
Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.
A total of 71 ELD flaps with immediate lipofilling were performed. Forty-five reconstructions were immediate and the remaining 26 delayed. Median (range) volume of autologous fat injected immediately was 171 ml (40-630 ml). Contralateral reductions were performed in 25 patients with the median reduction volume 185 g (89-683 g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection requiring intravenous antibiotics occurred in five patients (7%). In 5 patients wound dehiscence occurred, and only two of these required resuturing (3%). In total, 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with no needing reoperation (4%).
Our experience represents the largest series to date and shows that in carefully selected patients the technique is safe, can avoid the requirement for implants, and has the potential to streamline the reconstructive journey.
背阔肌肌皮瓣是自体乳房重建的常用选择。为显著增加乳房体积，我们报告了使用即刻脂肪填充的扩大背阔肌（ELD）皮瓣的经验，并表明其是自体乳房重建的有效选择。
纳入2013年12月至2016年6月期间接受该手术的患者。分析了人口统计学、临床和手术因素，以及住院期间的发病率和术后住院时间。
共进行了71例即刻脂肪填充的ELD皮瓣手术。45例为即刻重建，其余26例为延迟重建。即刻注射的自体脂肪中位数（范围）为171毫升（40 - 630毫升）。25例患者进行了对侧乳房缩小术，缩小体积中位数为185克（89 - 683克）。中位住院时间为6.5（3 - 18）天，患者随访12个月（1 - 37）。发生了3例皮瓣完全失败，不得不切除（4%）。发生1例血肿需要引流（1%）。5例患者出现需要静脉使用抗生素的感染迹象（7%）。5例患者发生伤口裂开，其中仅2例需要再次缝合（3%）。共有7例患者出现血清肿需要反复引流（10%）。3例重建出现轻度乳房切除皮瓣坏死，无需再次手术（4%）。
我们的经验是迄今为止最大的系列报道，表明在精心挑选的患者中，该技术是安全的，可以避免使用植入物，并有可能简化重建过程。
