Pan Lihui, Zhen Huifen, Jia Miaomiao, Ding Chao, Zhang Xiaojun, Gao Jinnan, Guo Fan
Department of Breast Surgery, The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital (Tongji Hospital of Shanxi), Taiyuan, China.
Gland Surg. 2024 Jun 30;13(6):794-801. doi: 10.21037/gs-23-484. Epub 2024 Jun 21.
Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high probability of recurrence after treatment. There is a variety of available treatments for PDM, but none of these options have been widely accepted. A standard strategy has been especially difficult to establish in patients with PDM accompanied by large tumors or large skin ruptures, as these seriously affect the appearance of the breasts after surgeries, which can lead to feelings of lower self-esteem among patients. Therefore, finding a reliable volume replacement has become a focus of our research efforts. With the widespread use of latissimus dorsi in breast reconstruction, we attempted to use the latissimus muscle (skin) flap for stage I repair in patients with large-defect PDM. Our study is the first of its kind to evaluate the clinical effect and patient satisfaction of the latissimus dorsi myocutaneous flap (LDMF) technique in PDM.
Thirty-two patients with PDM and more than about 20% loss of breast volume admitted to the Department of Breast Surgery of Shanxi Bethune Hospital from March 2017 to July 2021 were enrolled. After lesion removal, the LDMF technique was applied to these patients for immediate completion of breast contour revision. All patients were periodically followed up to assess the efficacy of the procedure and their satisfaction with the breasts' shape.
Three patients (9.4%) developed dorsal effusion after removal of the back drain; six patients (18.8%) developed mild limitation of the activity of the affected upper limb; and three patients (9.4%) experienced local recurrence of inflammation after the operation, all of whom underwent a second operation. The cure rate of the patients treated with LDMF was 90.6%, the overall satisfaction rate of the patients was 96.9%, and doctor's evaluation of satisfaction was 90.6%.
In patients with poor results after anti-infective and local treatment and those with more than 20% defect volume following lesion removal, the LDMF technique yields a high cure rate and good patient satisfaction.
导管周围乳腺炎（PDM）是一种复杂的良性乳腺疾病，病程较长，治疗后复发概率较高。PDM有多种可用的治疗方法，但这些方法均未被广泛接受。在伴有大肿瘤或大面积皮肤破裂的PDM患者中，尤其难以制定出标准的治疗策略，因为这些情况会严重影响术后乳房外观，进而可能导致患者自尊心下降。因此，寻找可靠的组织替代物已成为我们研究工作的重点。随着背阔肌在乳房重建中的广泛应用，我们尝试将背阔肌（皮）瓣用于大缺损PDM患者的一期修复。我们的研究是同类研究中首个评估背阔肌肌皮瓣（LDMF）技术治疗PDM的临床效果及患者满意度的研究。
选取2017年3月至2021年7月在山西白求恩医院乳腺外科住院治疗的32例PDM患者，这些患者乳房体积损失超过约20%。在病灶切除后，对这些患者应用LDMF技术立即完成乳房外形修复。所有患者均定期随访，以评估手术效果及对乳房外形的满意度。
3例患者（9.4%）在拔除背部引流管后出现背部积液；6例患者（18.8%）患侧上肢活动出现轻度受限；3例患者（9.4%）术后出现局部炎症复发，均接受了二次手术。采用LDMF技术治疗的患者治愈率为90.6%，患者总体满意率为96.9%，医生评估的满意率为90.6%。
对于抗感染及局部治疗效果不佳且病灶切除后缺损体积超过20%的患者，LDMF技术治愈率高，患者满意度良好。
