Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan.
Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan.
Aesthetic Plast Surg. 2023 Aug;47(4):1335-1342. doi: 10.1007/s00266-023-03255-9. Epub 2023 Jan 25.
The extended latissimus dorsi (ELD) musculocutaneous flap is one of the surgical techniques used for breast reconstruction. Preoperative preparation to determine the exact amount of flap tissue to be harvested is important to achieve a good outcome with autologous tissue reconstruction. However, few reports exist on objective preoperative volume prediction of ELD flaps. The purpose of this study was to quantify the elevated ELD volume as a preoperative plan.
Patients who underwent immediate or delayed breast reconstruction with ELD flap after mastectomy between March 2015 and January 2022 are included. (1) The ELD flap was designed preoperatively, X-ray contrast thread was applied along the design, and CT imaging was performed in the same lateral supine position as the surgical position. 3D images were constructed, and the volume-rendering method was used to obtain the integrated volume. (2) Intraoperative ELD flap volume was calculated using the water displacement method. The correlation between (1) and (2) was examined.
(1) The mean preoperative predicted value was 290.2 mL and (2) the mean intraoperative ELD flap volume was 298.3 mL. The correlation coefficient between the two volumes was 0.93, indicating that they were correlated.
We could quantify the ELD flap volume using the volume-rendering method with X-ray contrast threads. This study could be a useful method for preoperative prediction planning of the ELD flap in breast reconstruction.
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延长型背阔肌（ELD）肌皮瓣是乳房重建中使用的一种手术技术。为了实现自体组织重建的良好效果，术前准备以确定要采集的皮瓣组织的确切数量非常重要。然而，关于 ELD 皮瓣的客观术前体积预测的报道很少。本研究旨在量化抬高的 ELD 体积作为术前计划。
纳入 2015 年 3 月至 2022 年 1 月间接受 ELD 皮瓣即刻或延迟乳房重建的患者。（1）术前设计 ELD 皮瓣，沿设计应用 X 射线对比线，并在与手术位置相同的侧卧位进行 CT 成像。构建 3D 图像，并使用体积渲染方法获得整体体积。（2）使用排水法计算术中 ELD 皮瓣的体积。检查（1）和（2）之间的相关性。
（1）术前预测值的平均值为 290.2 mL，（2）术中 ELD 皮瓣的平均值为 298.3 mL。两者之间的相关系数为 0.93，表明两者相关。
我们可以使用带有 X 射线对比线的体积渲染方法量化 ELD 皮瓣的体积。这项研究可能是乳房重建中 ELD 皮瓣术前预测规划的有用方法。
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