Lokejareonlarb Santi, Chamalerk Panyawat
J Med Assoc Thai. 2017 Feb;100 Suppl 1:S157-64.
Latissimus Dorsi flap (LD flap) has been used since the eighteenth century to cover large chest wall defects after total mastectomy and is thought to be superior to split thickness skin graft in terms of both cosmetic results and functionality. The outcomes and complications resulting from the use of LD flap reconstruction for large breast cancer are not well documented in Thailand.
To describe a technique using the Latissimus Dorsi musculocutaneous flap for breast reconstruction. The outcomes, complications and length of stay after operation were also reported.
Between 2009 and 2014, fifty-five patients with large breast cancer with skin involvement were selected. Of these, forty-four cases had modified radical mastectomy (MRM) alone, and eleven cases underwent total mastectomy with immediate LD flap chest wall reconstruction. The age of the patients ranged from 33 to 81 years. The flaprelated complications and donor site morbidity were evaluated. This retrospective study was reviewed and approved by the ethics committee, Rajavithi Hospital.
The eleven patients with LD flap for breast reconstruction had a mean age of 53.82±14.50 years (range 33 to 81). All tumors were T4 lesions, and the mean tumor size was 15 cm. Average body mass index (BMI) was 23.83±4.18 kg/m2, hematocrit (Hct) was 34.90±4.06% and albumin (Alb) was 3.68±1.03 mg/dl. Three patients had diabetes mellitus and two had hypertension. Six of these LD flap patients had the following postoperative complications: wound infections (36.36%); wound dehiscence (27.27%); seroma (18.18%); and partial flap loss (27.27%). No patient had total flap loss. Mean drainage durations of chest and axillary were 7.73 day and 8.09 days respectively, and mean length of hospital stay (LOS) was 20.00±16.72 days. The median tumor size in the LD flap group was significantly bigger than that of the MRM group (15 vs. 3.6 cm, p<0.001). There were no significant differences between MRM and LD flap in terms of gender, age, marital status, BMI, Hct, Albor underlying diseases.
LD flap is a safe option for autologous breast reconstruction, although donor-site complications are often observed. A larger series to investigate the results and adverse effects of this procedure is needed.
自18世纪以来，背阔肌肌皮瓣（LD瓣）就被用于全乳切除术后覆盖大面积胸壁缺损，并且在美容效果和功能方面被认为优于断层皮片移植。在泰国，关于使用LD瓣重建术治疗大型乳腺癌的结果和并发症的记录并不完善。
描述一种使用背阔肌肌皮瓣进行乳房重建的技术。同时报告术后的结果、并发症及住院时间。
选取2009年至2014年间55例有皮肤受累的大型乳腺癌患者。其中，44例仅接受了改良根治性乳房切除术（MRM），11例接受了全乳切除并即刻进行LD瓣胸壁重建。患者年龄在33岁至81岁之间。评估了与皮瓣相关的并发症和供区发病率。这项回顾性研究经过拉贾维蒂医院伦理委员会的审查和批准。
11例行LD瓣乳房重建的患者平均年龄为53.82±14.50岁（范围33至81岁）。所有肿瘤均为T4期病变，平均肿瘤大小为15厘米。平均体重指数（BMI）为23.83±4.18kg/m²，血细胞比容（Hct）为34.90±4.06%，白蛋白（Alb）为3.68±1.03mg/dl。3例患者患有糖尿病，2例患有高血压。这11例LD瓣患者中有6例出现了以下术后并发症：伤口感染（36.36%）；伤口裂开（27.27%）；血清肿（18.18%）；部分皮瓣坏死（27.27%）。没有患者出现皮瓣完全坏死。胸部和腋窝的平均引流时间分别为7.73天和8.09天，平均住院时间（LOS）为20.00±16.72天。LD瓣组的肿瘤大小中位数显著大于MRM组（15厘米对3.6厘米，p<0.001）。在性别、年龄、婚姻状况、BMI、Hct、Alb或基础疾病方面，MRM组和LD瓣组之间没有显著差异。
LD瓣是自体乳房重建的一种安全选择，尽管经常观察到供区并发症。需要进行更大规模的系列研究来调查该手术的结果和不良反应。
