Escandón Joseph M, Manrique Oscar J, Christiano Jose G, Mroueh Vanessa, Prieto Peter A, Gooch Jessica C, Weiss Anna, Langstein Howard N
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
American University of Beirut Faculty of Medicine, Beirut, Lebanon.
Ann Transl Med. 2023 Aug 30;11(10):355. doi: 10.21037/atm-23-469. Epub 2023 May 24.
The latissimus dorsi flap (LDF) has gained popularity given its versatile nature and broad applicability in breast reconstruction. Its resurgence has been attributed to its ability to be enhanced using implant or high-volume fat grafting, rendering it a primary option for selected patients. The aim of this review is to tackle current indications and subjects of controversy regarding use of complete-autologous and implant-enhanced LDF in breast reconstruction. Also, a case-series showcasing the authors' experience with this versatile reconstructive option is presented. A search across Web of Science and PubMed MEDLINE from inception through January 3, 2023, was conducted. Articles reporting postoperative outcomes of autologous breast reconstruction with LDF were included. Regarding the case series, electronic medical records of patients who underwent total mastectomy and autologous breast reconstruction with LDF from January 2011 to December 2021 were retrospectively reviewed. Data on demographic and oncologic characteristics, and surgical characteristics and outcomes were extracted. Our review suggests that LDF is suitable for patients who lack alternative donor site, have a history of abdominoplasty or no access to microsurgery, smokers or obese. Latissimus dorsi (LD) harvesting has almost complete shoulder function recovery in the long-term. Thoracodorsal nerve division does not cause volume loss or animation deformity. Multisite multilayer fat grafting, beveling the edges of the skin paddle and fat, folding the LD muscle and plicating the paddle allow adequate projection and contour achievement. Our case-series included 234 reconstructions. Almost half of the patients had immediate fat transfer during reconstruction (51.3%). The rate of recipient site hematoma was 3.0%, seroma was 7.7%, wound disruption 32.1%, wound disruption events requiring unplanned procedures was 13.7%, and surgical site infection (SSI) was 12.4%. The LDF is reliable and safe for immediate or delayed breast reconstruction or salvage after reconstruction failure. Its versatility, reliable anatomy, easy dissection, and relative low complication rate have revived this modality as valuable opportunity for breast reconstruction in this era.
背阔肌肌皮瓣（LDF）因其多功能性和在乳房重建中的广泛适用性而受到欢迎。它的再度流行归因于其可通过植入物或大量脂肪移植得到增强，使其成为特定患者的主要选择。本综述的目的是探讨在乳房重建中使用完全自体和植入物增强的LDF的当前适应症和争议话题。此外，还展示了一个病例系列，介绍了作者在这种多功能重建方法方面的经验。对从创刊到2023年1月3日的Web of Science和PubMed MEDLINE进行了检索。纳入了报告LDF自体乳房重建术后结果的文章。关于病例系列，回顾性分析了2011年1月至2021年12月接受全乳切除和LDF自体乳房重建患者的电子病历。提取了人口统计学和肿瘤学特征、手术特征及结果的数据。我们的综述表明，LDF适用于缺乏其他供区、有腹壁成形术史或无法进行显微手术、吸烟或肥胖的患者。长期来看，背阔肌（LD）切取后肩部功能几乎能完全恢复。胸背神经切断不会导致体积丢失或动态畸形。多部位多层脂肪移植、将皮瓣边缘和脂肪修成斜面、折叠LD肌肉并折叠皮瓣可实现足够的突出度和塑形。我们的病例系列包括234例重建手术。几乎一半的患者在重建过程中立即进行了脂肪移植（51.3%）。受区血肿发生率为3.0%，血清肿为7.7%，伤口裂开为32.1%，需要进行非计划手术的伤口裂开事件为13.7%，手术部位感染（SSI）为12.4%。LDF用于即刻或延迟乳房重建或重建失败后的挽救是可靠且安全的。其多功能性、可靠的解剖结构、易于解剖以及相对较低的并发症发生率使这种方法在这个时代重新成为乳房重建的宝贵选择。
