Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm
Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm
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用于复杂乳房重建的背阔肌肌皮瓣：适应症、结果和拟议算法
DOI：
10.1097/gox.0000000000002382
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
M. Nahabedian
中科院分区：
文献类型：
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作者：
G. Kokosis;Nima Khavanin;M. Nahabedian
目的：背阔肌皮瓣是一种理想的皮瓣挽救失败后，首次乳房再造的放射治疗设置。本研究将回顾使用LD皮瓣进行二次重建后的结果，使用或不使用组织扩张器（TE）或植入物（I）。研究方法：纳入了以下4个队列：28例患者（48.3%）为1期LD，7例患者（12.1%）为1期LD + I，8例患者（13.8%）为2期LD + TE/I，15例患者（25.9%）为3期LD + TE + I。结果：所有患者的平均年龄为53.2岁。4个队列的并发症无显著差异。并发症包括部分皮瓣坏死、伤口裂开、血清肿和感染，发生在28例1期单纯LD患者中的4例、7例1期LD + I患者中的2例（28.6%）、8例2期LD + TE/I患者中的5例（52.5%）和15例3期LD + TE + I患者中的4例（26.7%）（P = 0.055）。4个队列的再手术率分别为10.7%、14.3%、25%和0%（P = 0.295）。仅LD队列的手术翻修率为14.3%，而1期+I组为42.9%，2期+TE/I组为50%，3期LD + TE + I组为33.3%（P = 0.135）。4个队列的对侧对称手术率分别为10.7%、0%、25%和6.7%（P = 0.410）。结论：LD皮瓣一期、二期或三期乳房再造均获成功。提供了一种决策算法。
Purpose: The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I). Methods: The following 4 cohorts were included: 1-stage LD only in 28 patients (48.3%), 1-stage LD + I in 7 patients (12.1%), 2-stage LD + TE/I in 8 patients (13.8%), and 3-stage LD + TE + I in 15 patients (25.9%). Results: The average age across all patients was 53.2 years. Complications did not differ significantly across the 4 cohorts. Complications included partial flap necrosis, wound dehiscence, seroma, and infection occurring in 4 of 28 patients of 1-stage LD alone, 2 of 7 (28.6%) patients of 1-stage LD + I, 5 of 8 (52.5%) patients of 2-stage LD + TE/I, and 4 of 15 (26.7%) patients of 3-stage LD + TE + I (P = 0.055). Reoperation rates were 10.7%, 14.3%, 25%, and 0% across the 4 cohorts, respectively (P = 0.295). The LD only cohort had a 14.3% surgical revision rate, compared with 42.9% in the 1-stage + I, 50% in the 2-stage + TE/I, and 33.3% in the 3-stage LD + TE + I (P = 0.135). The rate of contralateral symmetry procedures was 10.7%, 0%, 25%, and 6.7%, across the 4 cohorts, respectively (P = 0.410). Conclusion: Secondary breast reconstruction with the LD flap in 1, 2, or 3 stages has demonstrated success. A decision-making algorithm is provided.