Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, School of Medicine, Rome (Italy).
Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, School of Medicine, Rome (Italy).
J Plast Reconstr Aesthet Surg. 2022 Oct;75(10):3673-3682. doi: 10.1016/j.bjps.2022.06.078. Epub 2022 Jun 28.
Patients presenting breast actinic damage or implant-related complications require an autologous approach to breast reconstruction. However, when they are not good candidates for microsurgical procedures, alternative solutions must be sought. Latissimus dorsi (LD) is a workhorse flap in breast reconstruction, but often the amount of skin and volume achievable are insufficient. Taking inspiration from the Kiss flap concept, the authors hereby describe the "Kiss" LD flap to achieve totally autologous breast reconstruction.
A prospective service evaluation of all patients who underwent breast reconstruction with Kiss LD flap between 2018 and 2020 was performed. Patient demographics and operative variables were recorded, together with early and late complications. Patient satisfaction and quality of life were registered using the latest BREAST-Q reconstruction module, which includes specific LD scales. The questionnaire was administered to patients preoperatively and six months postoperatively.
Thirty patients underwent total autologous breast reconstruction with Kiss LD flap. Breast cancer and breast sarcoma resection were followed by reconstruction. The timing of reconstruction was immediate in 3 cases and delayed in 27 cases. No major complications nor total flap loss were registered. BREAST-Q scores postoperatively were significantly higher than the preoperative ones in every domain (p<0.0001) except for the physical well-being of back and shoulder, where the scores differed slightly and non-significantly (p=0.05).
The Kiss LD flap allows to harvest a large amount of skin to restore the breast envelope and a considerable volume to reconstruct the breast mound in a completely autologous procedure.
患有日光性乳房损伤或与植入物相关并发症的患者需要采用自体方法进行乳房重建。但是，如果他们不适合进行显微外科手术，则必须寻找替代解决方案。Latissimus dorsi（LD）是乳房重建中的主力皮瓣，但通常可获得的皮肤和体积量不足。受 Kiss 皮瓣概念的启发，作者在此描述了“Kiss”LD 皮瓣，以实现完全自体的乳房重建。
对 2018 年至 2020 年间接受 Kiss LD 皮瓣乳房重建的所有患者进行了前瞻性服务评估。记录了患者的人口统计学和手术变量，以及早期和晚期并发症。使用最新的 BREAST-Q 重建模块（包括特定的 LD 量表）来记录患者的满意度和生活质量。问卷在术前和术后 6 个月进行。
30 名患者接受了 Kiss LD 皮瓣的全自体乳房重建。乳房癌和乳房肉瘤切除术后进行了重建。3 例即刻重建，27 例延迟重建。未发生重大并发症或全部皮瓣坏死。除背部和肩部的身体舒适度略有不同且无统计学意义（p=0.05）外，术后 BREAST-Q 评分在每个领域均明显高于术前（p<0.0001）。
Kiss LD 皮瓣可大量采集皮肤来恢复乳房包膜，并可采集大量体积来在完全自体的手术中重建乳房丘。
