Lee Hyung Chul, Lee Jaemin, Park Seung-Ha, Yoon Eul-Sik
From the Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.
Ann Plast Surg. 2021 Apr 1;86(4):394-399. doi: 10.1097/SAP.0000000000002565.
The implant-enhanced latissimus dorsi (LD) flap, or a hybrid LD flap, is widely used in certain indications, even though abdominal-based flaps are now considered the gold standard of autologous breast reconstruction. However, few articles distinguish the hybrid LD flap from traditional LD flaps, and not many articles have compared the surgical outcomes, with the abdominal-based flap procedure, especially in the area of immediate breast reconstruction. In addition, it is often overlooked that the reported esthetic comparisons are based on different populations and contralateral balancing procedures (CBPs). Thus, this study aimed to review the reconstruction outcomes and to compare the variable-matched esthetic outcomes between 2 groups.
A retrospective review of patients who underwent immediate breast reconstruction with either a hybrid LD flap or an abdominal-based free flap and had completed at least 2 years of follow-up visits was carried out. The patient demographics, oncologic data, breast parameters, and postoperative outcomes were compared across the entire patient group. The body mass index (BMI)- and CBP-matched cohort was randomly selected and assessed using the Aesthetic Outcome parameter of the Aesthetic Item Scale.
Thirty-eight hybrid LD flap and 51 abdominal-based free flap procedures were included. The hybrid LD group showed a shorter operation time (330 ± 260 minutes vs 550 ± 480 minutes, respectively; P < 0.01), and fewer patients in the hybrid LD group underwent additional revision surgeries (7 [18.4%] vs 20 [39.2%], respectively; P < 0.01). Other complication rates were not significantly different between groups. A BMI- and CBP-matched esthetic analysis revealed that the hybrid LD group showed superior results in symmetry (Mann-Whitney U test, P = 0.047).
The LD flap in combination with an implant remains a viable option in immediate breast reconstruction and had a similar complication profile while having a shorter operative time compared with the abdominal-based autologous breast reconstruction procedure. If properly used in certain populations, hybrid LD flaps may offer superior results regarding symmetry over the abdominal-based flap procedure.
尽管腹壁皮瓣目前被认为是自体乳房重建的金标准，但植入物增强的背阔肌（LD）皮瓣或混合LD皮瓣在某些适应症中仍被广泛使用。然而，很少有文章将混合LD皮瓣与传统LD皮瓣区分开来，并且与腹壁皮瓣手术相比，比较手术结果的文章也不多，尤其是在即刻乳房重建领域。此外，经常被忽视的是，所报道的美学比较是基于不同的人群和对侧平衡手术（CBP）。因此，本研究旨在回顾重建结果并比较两组之间可变匹配的美学结果。
对接受混合LD皮瓣或腹壁游离皮瓣即刻乳房重建且至少完成2年随访的患者进行回顾性研究。比较了整个患者组的患者人口统计学、肿瘤学数据、乳房参数和术后结果。随机选择体重指数（BMI）和CBP匹配的队列，并使用美学项目量表的美学结果参数进行评估。
纳入了38例混合LD皮瓣手术和51例腹壁游离皮瓣手术。混合LD组的手术时间较短（分别为330±260分钟和550±480分钟；P<0.01），并且混合LD组接受额外修复手术的患者较少（分别为7例[18.4%]和20例[39.2%]；P<0.01）。两组之间的其他并发症发生率没有显著差异。BMI和CBP匹配的美学分析显示，混合LD组在对称性方面表现出更好的结果（曼-惠特尼U检验，P=0.047）。
LD皮瓣联合植入物在即刻乳房重建中仍然是一个可行的选择，与腹壁自体乳房重建手术相比，并发症情况相似，但手术时间更短。如果在某些人群中正确使用，混合LD皮瓣在对称性方面可能比腹壁皮瓣手术提供更好的结果。
