Choo Joshua H, Vivace Bradley J, Meredith Luke T, Kachare Swapnil, Lee Thomas J, Kachare Milind, Wilhelmi Bradon J
Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA.
University of Louisville Medical School, KY, USA.
Plast Surg (Oakv). 2023 May;31(2):132-137. doi: 10.1177/22925503211031927. Epub 2021 Jul 14.
The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography-guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted of 0.682, < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted of 0.553, < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.
乳腺癌患者中肥胖发生率的不断上升促使人们重新审视背阔肌肌皮瓣（LDF）在乳房重建中的作用。尽管该皮瓣在肥胖患者中的可靠性已有充分记录，但尚不清楚通过单纯自体重建（如扩大筋膜下脂肪层的获取量）是否能获得足够的组织量。此外，传统的自体和假体联合方法（LDF + 扩张器/植入物）在肥胖患者中因皮瓣厚度导致与植入物相关的并发症发生率增加。本研究的目的是提供背阔肌皮瓣各组成部分厚度的数据，并讨论体重指数（BMI）增加的患者在乳房重建中的意义。在518例接受俯卧位计算机断层扫描引导下肺活检的患者中，测量了LDF通常供区的背部厚度。获取了软组织整体以及各层（如肌肉、筋膜下脂肪）的厚度。记录了患者的人口统计学数据，包括年龄、性别和BMI。观察到BMI范围为15.7至65.7。在女性中，背部总厚度（皮肤、脂肪、肌肉）范围为0.6至9.4厘米。BMI每增加1个单位，皮瓣厚度增加1.11毫米（校正后β为0.682，P <.001），筋膜下脂肪层厚度增加0.513毫米（校正后β为0.553，P <.001）。体重过轻、正常体重、超重以及I、II、III级肥胖个体的平均总厚度分别为1.0、1.7、2.4、3.0、3.6和4.5厘米。筋膜下脂肪层对皮瓣厚度的平均贡献总体为8.2毫米（32%），在正常体重、超重、I级、II级、III级肥胖个体中分别为3.4毫米（21%）、6.7毫米（29%）、9.0毫米（30%）、11.1毫米（32%）和15.6毫米（35%）。上述发现表明，LDF整体厚度和筋膜下层厚度与BMI密切相关。随着BMI增加，筋膜下层对皮瓣总厚度的贡献百分比趋于增加，这有利于扩大LDF的获取量。由于在检查中该层无法与总厚度分离，这些结果有助于估计扩大背阔肌获取技术所获得的额外组织量。
