Zheng Shuyue, Hao Shuang, Chen Jiajian, Zhang Yingying, Yang Benlong, Huang Xiaoyan, Liu Guangyu, Shao Zhimin, Wu Jiong
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Oncol. 2023 Jul 20;13:1159073. doi: 10.3389/fonc.2023.1159073. eCollection 2023.
The latissimus dorsi flap (LDF) is the most commonly used autologous flap for breast reconstruction (BR) in China. We conducted this study to explore the current status of BR using LDF with/without implants.
This study was a single-center retrospective study that included breast tumor patients who underwent LDF breast reconstruction at Fudan University Shanghai Cancer Center (FUSCC) between 2000 and 2021.
We analyzed 4918 patients who underwent postmastectomy BR, including 1730 patients (35.2%) with autologous flaps. LDF was used for BR in 1093 (22.2%) patients, and an abdominal flap was used in 637 (13.0%) patients. The proportion of LDFs used in autologous BR patients decreased each year and dropped to approximately 65.0% after 2013 due to the increased use of abdominal flaps. Among these patients, 609 underwent extended LDF (ELDF) BR, 455 underwent LDF BR with implants, and 30 received a LDF as a salvage flap due to previous flap or implant failure. Patients who underwent ELDF reconstruction were older and had a higher BMI than those who received a LDF with implants. There was no significant difference in the mean postoperative hospital stay, neoadjuvant chemotherapy rates, or adjuvant radiotherapy rates between the two groups. Major complications requiring surgical intervention occurred in 25 patients (2.29%). There was no significant difference in the incidence of major complications between the two groups (=0.542).
LDF breast reconstruction is a well-developed and safe procedure. The duration of postoperative hospitalization nor the incidence of major complications was affected by implant use.
在我国，背阔肌肌皮瓣（LDF）是乳房重建（BR）最常用的自体皮瓣。我们开展本研究以探讨采用带/不带植入物的LDF进行BR的现状。
本研究为单中心回顾性研究，纳入了2000年至2021年间在复旦大学附属肿瘤医院（FUSCC）接受LDF乳房重建的乳腺肿瘤患者。
我们分析了4918例乳房切除术后接受BR的患者，其中1730例（35.2%）采用自体皮瓣。1093例（22.2%）患者使用LDF进行BR，637例（13.0%）患者使用腹直肌肌皮瓣。由于腹直肌肌皮瓣使用增加，自体BR患者中LDF的使用比例逐年下降，2013年后降至约65.0%。在这些患者中，609例接受了扩大背阔肌肌皮瓣（ELDF）BR，455例接受了带植入物的LDF BR，30例因先前皮瓣或植入物失败接受LDF作为挽救皮瓣。接受ELDF重建的患者比接受带植入物LDF的患者年龄更大且BMI更高。两组患者术后平均住院时间、新辅助化疗率或辅助放疗率无显著差异。25例（2.29%）患者发生需要手术干预的主要并发症。两组主要并发症发生率无显著差异（P = 0.542）。
LDF乳房重建是一种成熟且安全的手术。植入物的使用不影响术后住院时间和主要并发症的发生率。
