Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany.
Department of Gynecology and Obstetrics and Breast Cancer Center, Regio Klinikum Pinneberg, Pinneberg, Germany.
Arch Gynecol Obstet. 2024 Jan;309(1):269-280. doi: 10.1007/s00404-023-07186-3. Epub 2023 Aug 16.
The use of autologous tissues is considered gold standard for patients undergoing breast reconstruction and is the preferred method in the post-radiation setting. Although the latissimus dorsi flap (LDF) has been replaced by abdominal flaps as technique of choice, it remains a valuable option in several specific clinical situations and its use has been regaining popularity in recent years. In this work, we present an 18-year retrospective analysis of a single-institution single-surgeon experience with LDF-based reconstruction with focus on early complications and reconstructive failures.
Hospital records of all patients undergoing breast surgery for any reason in the Certified Breast Cancer Center, Regio Klinikum Pinneberg, Germany between April, 1st 2005 and October, 31st 2022 were reviewed. 142 consecutive LDF-based reconstructive procedures were identified. Detailed information was gathered on patient characteristics, treatment-related factors, and complications.
One hundred forty patients (139 female, 1 male) received 142 LDF-based surgeries. The flap was used mainly for immediate breast reconstruction with or without implant (83% of patients), followed by defect coverage after removal of a large tumor (7%), implant-to-flap conversion with or without placement of a new implant (6%), and delayed post-mastectomy reconstruction (4%). The use of LDF decreased between 2005 and 2020 (2005: 17, 2006: 13, 2007: 14, 2008: 16, 2009: 5, 2010: 9, 2011: 8, 2012: 3, 2013: 10, 2014: 8, 2015: 8, 2016: 7, 2017: 7, 2018: 4, 2019: 4, 2020: 2, 2021: 6, 2022: 4). Surgery was performed for invasive breast cancer in 78%, ductal carcinoma in situ in 20% and other reasons such as genetic mutation in 1% of patients. Ipsilateral radiation therapy was received by 12% of patients prior to LDF surgery and by 37% after the surgery. 25% of patients were smokers. The median duration of surgery, including all procedures conducted simultaneously such as e.g., mastectomy, axillary surgery, or implant placement, was 117 min (range 56-205). Patients stayed in the hospital for a median of 7 days (range 2-23 days). The most common complication was seroma (26%), followed by wound dehiscence (8%), surgical site infection (7%), partial skin and/or nipple necrosis of any size (7%) and hematoma requiring surgical evacuation (2%). 19% of all patients required seroma aspiration or drainage, mostly at the donor site and performed under ultrasound guidance in the ambulatory setting. Flap loss due to necrosis occurred in 2% of patients.
Latissimus dorsi flap is a well-established surgical technique commonly used for immediate breast reconstruction as well as defect coverage in locally advanced breast cancer. To the best of our knowledge, this is one of the largest single-surgeon analyses of early complications in patients receiving LDF. As expected, seroma was the most common complication observed in nearly one third of patients and requiring a therapeutic intervention in every fifth patient. Serious adverse events occurred rarely, and flap loss rate was very low.
自体组织的使用被认为是接受乳房重建的患者的金标准，并且是放射治疗后首选的方法。尽管 latissimus dorsi 皮瓣（LDF）已被腹部皮瓣取代作为首选技术，但在某些特定临床情况下，它仍然是一种有价值的选择，并且近年来其使用再次变得流行。在这项工作中，我们对一家机构的一位外科医生的 18 年回顾性分析了 LDF 为基础的重建经验，重点是早期并发症和重建失败。
对德国雷焦克林姆皮恩伯格认证乳腺癌中心 2005 年 4 月 1 日至 2022 年 10 月 31 日期间因任何原因接受乳房手术的所有患者的医院记录进行了回顾。确定了 142 例连续的 LDF 重建手术。详细收集了患者特征、治疗相关因素和并发症等信息。
140 名患者（139 名女性，1 名男性）接受了 142 例 LDF 手术。该皮瓣主要用于即时乳房重建，伴有或不伴有植入物（83%的患者），其次是在切除大肿瘤后进行缺损覆盖（7%），带有或不带有新植入物的植入物到皮瓣转换（6%），以及延迟乳房切除术后重建（4%）。2005 年至 2020 年期间，LDF 的使用减少（2005 年：17 例，2006 年：13 例，2007 年：14 例，2008 年：16 例，2009 年：5 例，2010 年：9 例，2011 年：8 例，2012 年：3 例，2013 年：10 例，2014 年：8 例，2015 年：8 例，2016 年：7 例，2017 年：7 例，2018 年：4 例，2019 年：4 例，2020 年：2 例，2021 年：6 例，2022 年：4 例）。手术是为浸润性乳腺癌进行的，占 78%，导管原位癌占 20%，其他原因如遗传突变占 1%。在 LDF 手术前，12%的患者接受了同侧放射治疗，手术后 37%的患者接受了放射治疗。25%的患者吸烟。包括同时进行的所有手术程序（如乳房切除术、腋窝手术或植入物放置）在内，手术的中位持续时间为 117 分钟（范围 56-205 分钟）。患者中位住院时间为 7 天（范围 2-23 天）。最常见的并发症是血清肿（26%），其次是伤口裂开（8%）、手术部位感染（7%）、大小不一的皮肤和/或乳头坏死（7%）和需要手术清除的血肿（2%）。19%的患者需要进行血清肿抽吸或引流，主要在供体部位，在门诊环境下在超声引导下进行。由于坏死导致皮瓣丧失的发生率为 2%。
Latissimus dorsi 皮瓣是一种成熟的外科技术，常用于即时乳房重建以及局部晚期乳腺癌的缺损覆盖。据我们所知，这是对接受 LDF 的患者早期并发症进行的最大规模的单一外科医生分析之一。正如预期的那样，血清肿是观察到的近三分之一患者中最常见的并发症，需要对每五分之一的患者进行治疗干预。严重不良事件很少发生，皮瓣丧失率非常低。
