Pedicled Descending Branch Latissimus Dorsi Mini-flap for Repairing Partial Mastectomy Defect: A New Technique
Pedicled Descending Branch Latissimus Dorsi Mini-flap for Repairing Partial Mastectomy Defect: A New Technique
复制标题
带蒂降支背阔肌微型皮瓣修复乳房部分切除缺损的新技术
DOI：
10.1097/gox.0000000000001692
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发表时间：
2018-03-01
影响因子：
1.5
通讯作者：
Tang, Jun
中科院分区：
文献类型：
--
作者：
Cai, Ruizhao;Xie, Zeming;Tang, Jun
体积丢失是影响乳房部分切除术(PM)后美容效果的主要因素之一，尤其是对较小的乳房，因此，体积替换是优化最终美容效果的关键。我们提出了一种新的技术，提出了一种新的技术，提出了一种带蒂背阔肌降支(LD)微型皮瓣，用于腋下切开修复PM缺损区。PM后，通过现有的腋窝切开或前哨淋巴结活检获取LD微型皮瓣。仔细辨认和分离胸背血管和神经的降支。横支受到保护，以维持肌肉的神经和功能。然后在背部和下方破坏LD肌肉，在LD肌肉和浅筋膜之间形成一个肌下口袋和一个皮下口袋。一旦亚肌层形成，肌肉就沿着肌肉深层的纤维分裂，包括肌肉上方的一层脂肪。最后，将迷你瓣转移到乳房缺损处。鉴于LD微型瓣的长度和移动性有限，该入路最适用于侧方乳房缺损。然而，对于内侧缺损，则将外侧乳房组织重新排列以重建内侧乳房缺损，然后使用LD微型皮瓣重建外侧乳房供区。因此，这种技术可以用来重建乳房的所有象限，并能在背部没有疤痕的情况下提供美学效果，并最大限度地减少LD肌肉功能障碍。
Volume loss is 1 of the major factors influencing cosmetic outcomes of breast after partial mastectomy (PM), especially for smaller breasts, and therefore, volume replacement is critical for optimizing the final aesthetic outcome. We present a novel technique of raising a pedicled descending branch latissimus dorsi (LD) mini-flap for reconstruction of PM defects via an axillary incision. After PM, the LD mini-flap is harvested through the existing axillary incision of the axillary dissection or the sentinel lymph node biopsy. The descending branches of thoracodorsal vessels and nerve are carefully identified and isolated. The transverse branches are protected to maintain muscle innervation and function. The LD muscle is then undermined posteriorly and inferiorly to create a submuscular pocket and a subcutaneous pocket between LD muscle and superficial fascia. Once the submuscular plane is created, the muscle is divided along the muscle fibers from the deep surface including a layer of fat above the muscle. Finally, the LD mini-flap is transferred to the breast defect. Given the limited length and mobility of the LD mini-flap, this approach is best utilized for lateral breast defects. However, for medial defects, the lateral breast tissue is rearranged to reconstruct the medial breast defect, and an LD mini-flap is then used to reconstruct the lateral breast donor site. This technique can therefore be employed to reconstruct all quadrants of the breast and can provide aesthetic outcomes without scars on the back, with minimal dysfunction of LD muscle.