From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2022 Sep 1;150(3):644e-654e. doi: 10.1097/PRS.0000000000009446. Epub 2022 Jul 6.
The latissimus dorsi muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. The authors investigated whether harvesting unilateral latissimus dorsi muscle for breast reconstruction could influence spinal posture in the long term.
Patients who underwent immediate unilateral breast reconstruction between 2002 and 2010 were reviewed. They were grouped according to reconstruction methods: latissimus dorsi muscle flap and tissue expander/implant. The Cobb angle was assessed twice at each of five different time points (preoperatively and 2, 4, 6, and 8 years postoperatively) by an independent physician blinded to the reconstruction modality. Postoperative scoliosis was defined as a mean Cobb angle greater than 10 degrees at 8 years postoperatively. The trends of changes in Cobb angle over time and the rates of postoperative scoliosis were compared between reconstruction methods.
In total, 153 women were analyzed, including 102 using latissimus dorsi muscle flap and 51 using tissue expander/implant, with a median follow-up of 103 months. The latissimus dorsi flap group showed enhanced trends of increasing postoperative Cobb angles as compared with the tissue expander/implant group, and the difference remained significant after adjusting for other variables ( p = 0.001). The rate of postoperative scoliosis was significantly higher in the latissimus dorsi flap group than in the control group ( p = 0.029). Multivariable analyses revealed that use of the latissimus dorsi flap was associated with a significantly increased rate of postoperative scoliosis.
Unilateral latissimus dorsi muscle flap harvest for breast reconstruction might be associated with changes in spinal posture in the long term.
阔背肌起自下胸段脊柱，附着广泛，在脊柱姿势稳定性中起辅助作用。作者研究了单侧阔背肌肌皮瓣用于乳房重建是否会长期影响脊柱姿势。
回顾了 2002 年至 2010 年间行即刻单侧乳房重建的患者。根据重建方法将其分为阔背肌皮瓣组和组织扩张器/植入物组。由一位独立的、对重建方式不知情的医生在五个不同时间点（术前及术后 2、4、6 和 8 年）两次评估 Cobb 角。术后脊柱侧凸定义为术后 8 年平均 Cobb 角大于 10 度。比较了两种重建方法之间 Cobb 角随时间变化的趋势和术后脊柱侧凸的发生率。
共分析了 153 名女性，其中 102 名使用阔背肌皮瓣，51 名使用组织扩张器/植入物，中位随访时间为 103 个月。与组织扩张器/植入物组相比，阔背肌皮瓣组术后 Cobb 角呈逐渐增大的趋势，且在调整其他变量后仍有显著差异（p=0.001）。阔背肌皮瓣组术后脊柱侧凸的发生率明显高于对照组（p=0.029）。多变量分析显示，使用阔背肌皮瓣与术后脊柱侧凸的发生率显著增加相关。
单侧阔背肌肌皮瓣用于乳房重建可能与脊柱长期姿势改变有关。
