Boudreau Colton, Boehm Kaitlin S, MacDonald Aevan, Williams Jason
Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Plast Reconstr Surg Glob Open. 2021 May 3;9(5):e3282. doi: 10.1097/GOX.0000000000003282. eCollection 2021 May.
Latissimus dorsi (LD) flap is a workhorse flap in breast reconstruction. Despite many advantages, the primary criticism of this flap is the requirement of a second surgery to exchange expansion devices for permanent implants. This study reports a single-stage reconstruction and outcomes wherein Spectrum devices (Mentor, Irving, TX), which serve as expanders and permanent implants, are used, and expansion ports are removed under local anesthetic.
A retrospective chart review of all patients undergoing LD flap reconstruction with Spectrum device by a single surgeon at a single center during a 10-year period was performed. All patients, unilateral/bilateral, immediate/delayed were included. Details of implants, surgical procedure(s), and follow-up visits were assessed for patient outcomes.
In total, 41 patients and 56 breasts were included. Of the total patients, 58.5% retained the Spectrum device and had the expansion port removed under local anesthetic. An estimated 6 major complications occurred (14.6%), requiring return to the operating room: 3 patients required a capsulectomy, 1 a capsulotomy/implant repositioning, one had loss of implant (infection), and 1 had venous congestion of the flap. Eleven minor complications occurred (26.8%): 5 seromas (3 at the breast site, 2 at the donor site), 3 delayed wound healings (2 at donor site, 1 at breast site), 1 mastectomy flap necrosis, 2 infections (1 at each breast site, 1 at donor site).
This study provides details of a single-stage LD flap with Spectrum device breast reconstruction that can be considered when performing an LD reconstruction. This technique is efficient and safe with comparable complication profile.
背阔肌（LD）皮瓣是乳房重建中的常用皮瓣。尽管有许多优点，但对该皮瓣的主要批评是需要进行二次手术，将扩张装置更换为永久性植入物。本研究报告了一种单阶段重建方法及结果，其中使用了兼具扩张器和永久性植入物功能的Spectrum装置（美国德克萨斯州欧文市的美敦力公司生产），并在局部麻醉下移除了扩张端口。
对一名外科医生在一个中心10年内为所有使用Spectrum装置进行LD皮瓣重建的患者进行回顾性病历审查。纳入所有单侧/双侧、即刻/延迟手术的患者。评估植入物、手术过程和随访的详细情况，以了解患者的预后。
共纳入41例患者和56个乳房。在所有患者中，58.5%保留了Spectrum装置，并在局部麻醉下移除了扩张端口。估计发生了6例主要并发症（14.6%），需要返回手术室：3例患者需要进行包膜切除术，1例需要进行包膜切开术/植入物重新定位，1例植入物丢失（感染），1例皮瓣出现静脉充血。发生了11例轻微并发症（26.8%）：5例血清肿（3例在乳房部位，2例在供区），3例伤口愈合延迟（2例在供区，1例在乳房部位），1例乳房切除皮瓣坏死，2例感染（每个乳房部位1例，供区1例）。
本研究提供了使用Spectrum装置进行单阶段LD皮瓣乳房重建的详细情况，在进行LD重建时可予以考虑。该技术高效且安全，并发症情况相当。
