Doan Leandra, Sam Andre-Philippe, Li Wai-Yee
From the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif.
Riverside School of Medicine, University of California, Riverside, Calif.
Plast Reconstr Surg Glob Open. 2024 May 9;12(5):e5791. doi: 10.1097/GOX.0000000000005791. eCollection 2024 May.
The pedicled latissimus dorsi myocutaneous flap (LDMCF) in autologous breast reconstruction has been superseded by abdominal free tissue transfer. Common complaints of the LDMCF include the asymmetric back scar, need for prosthesis, and high seroma rates. We believe that the LDMCF remains versatile, with distinct advantages over other autologous options: the flap can be harvested unilaterally or bilaterally, not 'burning any bridges' for future reconstruction in unilateral breast reconstruction; the recovery is relatively easy, without complications such as risk of long-term abdominal wall weakness; and the aesthetic results are comparable, if not superior, leading to a more "youthful" result.
We performed a retrospective review over an 8-year period.
A total of 106 patients underwent 110 breast reconstructions. Complications included four of 106 patients (3.8%) with seroma, three of 78 (3.8%) with periprosthetic implant infection, and one case of partial flap loss.
We learned the following: (1) Direct-to-implant can be performed in most LDMCF patients, avoiding the use of tissue expanders; (2) High BMI patients may not require an implant; (3) Back donor site aesthetics can be improved using a "bra-line-back-lift" approach; (4) Use of liposomal bupivacaine intercostal blocks and modified enhanced recovery after surgery protocol can reduce length-of-stay to overnight; (5) We achieved low seroma rates using topical fibrin glue and closed suction drains; (6) Low and high BMI patients who may not qualify for free tissue transfer are usually still surgical candidates with LDMCF; and (7) Short and long-term recovery are faster than free tissue transfer, with minimal long-term deficit.
在自体乳房重建中，带蒂背阔肌肌皮瓣（LDMCF）已被腹部游离组织移植所取代。LDMCF的常见问题包括背部瘢痕不对称、需要假体以及血清肿发生率高。我们认为，LDMCF仍然具有通用性，相对于其他自体选择具有明显优势：该皮瓣可单侧或双侧切取，在单侧乳房重建中不会为未来的重建“切断后路”；恢复相对容易，不会出现如长期腹壁无力等并发症；美学效果即使不更优也相当，能带来更“年轻”的效果。
我们进行了为期8年的回顾性研究。
共有106例患者接受了110次乳房重建。并发症包括106例患者中有4例（3.8%）出现血清肿，78例中有3例（3.8%）发生假体周围植入物感染，1例出现部分皮瓣坏死。
我们了解到以下几点：（1）大多数LDMCF患者可直接植入假体，避免使用组织扩张器；（2）高体重指数患者可能不需要植入假体；（3）采用“胸罩线背部提升”方法可改善背部供区美观度；（4）使用脂质体布比卡因肋间阻滞和改良的术后强化康复方案可将住院时间缩短至过夜；（5）我们使用局部纤维蛋白胶和封闭式负压引流管使血清肿发生率较低；（6）可能不符合游离组织移植条件但体重指数高低不同的患者通常仍是LDMCF的手术候选者；（7）短期和长期恢复比游离组织移植更快，长期缺陷最小。
