The application of latissimus dorsi myocutaneous flap in the breast reconstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FENG Yueqing , ZHOU Yong , ZHAO Hui

Department of Head & Neck, Breast Surgery, Central Hospital of XinXiang, Xinxiang, Henan 453000, P. R. China;

Corresponding author：

FENG Yueqing, Email: 15637359823@163.com

Keywords：

breast tumor; latissimus dorsi myocutaneous flap; breast reconstruction

DOI：

10.7507/1007-9424.201705034

Video：

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Objective To explore the value of the application of latissimus dorsi myocutaneous flap in the breast reconstruction. Methods The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235–490 min (mean of 325 min), the intraoperative blood loss was 200–260 mL (mean of 220 mL), and the hospitalization time was 18–33 d (mean of 23.6 d). The total operative time of patients who underwent delayed breast reconstruction was 325–550 min (mean of 355 min), the total intraoperative blood loss was 200–250 mL (mean of 220 mL), and the total hospitalization time was 27–45 d (mean of 32.5 d). The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% (30/36). There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3–60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function. Conclusion The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.

Citation： FENG Yueqing, ZHOU Yong, ZHAO Hui. The application of latissimus dorsi myocutaneous flap in the breast reconstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1365-1370. doi: 10.7507/1007-9424.201705034 Copy

1.	邵志敏, 余科达. 乳腺外科的发展趋势. 中国普外基础与临床杂志, 2007, 14(3): 252-254.
2.	江泽飞, 李健斌. 精准医学时代乳腺外科十个热点问题思考. 中华普外科手术学杂志(电子版), 2016, 10(3): 192-196.
3.	Lee MA, Miteff KG. The scarless latissimus dorsi flap provides effective lower pole prosthetic coverage in breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(5): e147.
4.	Grotting JC, Robert J著; 范巨峰, 江华, 李洪生, 等译. 麦卡锡整形外科学(第五分卷): 乳房(第3版). 北京: 人民卫生出版社, 2015: 318-327.
5.	Ahn S, Kim I, Kim J, 等著; 金光逸, 张晨, 王洁晴, 等译. 现代韩国乳房整形术. 沈阳: 辽宁科学技术出版社, 2016: 375-384.
6.	共识专家讨论组. 保留乳头乳晕复合体乳房切除术的专家共识与争议(2015 年版). 中国癌症杂志, 2016, 26(5): 476-480.
7.	Munhoz AM, Montag E, Filassi JR, et al. Immediate nipple-areola-sparing mastectomy reconstruction: an update on oncological and reconstruction techniques. World J Clin Oncol, 2014, 5(3): 478-494.
8.	杨华伟, 刘剑仑, 韦薇, 等. 乳腺癌术后Ⅰ期乳房重建 78 例报告. 广西医科大学学报, 2013, 30(2): 280-282.
9.	吴炅. 肿瘤整形技术在乳腺癌治疗中的应用. 临床外科杂志, 2016, 24(9): 660-662.
10.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015版). 中国癌症杂志, 2015, 25(9): 692-754.
11.	中华医学会整形外科学分会乳腺专业学组. 乳腺癌切除术后乳房再造临床指南. 中华肿瘤杂志, 2014, 36(11): 851-857.
12.	穆兰花, 辛敏强, 栾杰. 重建乳腺癌术后的研究现状及评价. 中华乳腺病杂志(电子版), 2011, 5(2): 49-52.穆兰花, 辛敏强, 栾杰.重建乳腺癌术后的研究现状及评价.中华乳腺病杂志（电子版）,2011,5（2）:49-52.
13.	何英, 邓宏武, 万能斌, 等. 现代医学模式影响下的乳腺癌手术方式递嬗. 医学与哲学, 2017, 38(4B): 27-30.
14.	陈颖, 陈嘉健, 陈嘉莹, 等. 中国乳腺癌术后乳房重建现况调查报告. 中华肿瘤杂志, 2014, 36(11): 851-857.
15.	熊凌云, 孙家明. 背阔肌肌皮瓣乳房重建的治疗现状与进展. 中国美容医学, 2010, 19(7): 1090-1093.
16.	卓睿. 即时扩展型背阔肌肌皮瓣乳房再造术常见失误及并发症探讨. 中华乳腺病杂志(电子版), 2010, 4(6): 692-700.
17.	Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg, 2012, 39(5): 509-513.
18.	Rifaat MA, Amin AA, Bassiouny M, et al. The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian J Plast Surg, 2008, 41(1): 24-33.
19.	卓睿. 乳腺癌即时扩展型背阔肌肌皮瓣乳房重建术中胸背神经的处理探讨. 广西中医学院学报, 2010, 13(4): 23-25.
20.	Cha HG, Kang SG, Shin HS, et al. Does fibrin sealant reduce seroma after immediate breast reconstruction utilizing a latissimus dorsi myocutaneous flap? Arch Plast Surg, 2012, 39(5): 504-508.
21.	Jagsi R, Jiang J, Momoh AO, et al. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg, 2016, 263(2): 219-227.
22.	Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol, 2014, 5(3): 181-187.
23.	Mohan AT, Saint-Cyr M. Anatomic and physiological fundamentals for autologous breast reconstruction. Gland Surg, 2015, 4(2): 116-133.
24.	Kääriäinen M, Giordano S, Kauhanen S, et al. No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study. J Plast Reconstr Aesthet Surg, 2014, 67(8): 1106-1110.
25.	González EG, Rancati AO. Skin-sparing mastectomy. Gland Surg, 2015, 4(6): 541-553.
26.	Ismagilov A, Vanesyan A, Kamaletdinov I. Small refinements in breast reconstruction: a technique for inframammary fold creation. Gland Surg, 2017, 6(2): 132-140.

1. 邵志敏, 余科达. 乳腺外科的发展趋势. 中国普外基础与临床杂志, 2007, 14(3): 252-254.
2. 江泽飞, 李健斌. 精准医学时代乳腺外科十个热点问题思考. 中华普外科手术学杂志(电子版), 2016, 10(3): 192-196.
3. Lee MA, Miteff KG. The scarless latissimus dorsi flap provides effective lower pole prosthetic coverage in breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(5): e147.
4. Grotting JC, Robert J著; 范巨峰, 江华, 李洪生, 等译. 麦卡锡整形外科学(第五分卷): 乳房(第3版). 北京: 人民卫生出版社, 2015: 318-327.
5. Ahn S, Kim I, Kim J, 等著; 金光逸, 张晨, 王洁晴, 等译. 现代韩国乳房整形术. 沈阳: 辽宁科学技术出版社, 2016: 375-384.
6. 共识专家讨论组. 保留乳头乳晕复合体乳房切除术的专家共识与争议(2015 年版). 中国癌症杂志, 2016, 26(5): 476-480.
7. Munhoz AM, Montag E, Filassi JR, et al. Immediate nipple-areola-sparing mastectomy reconstruction: an update on oncological and reconstruction techniques. World J Clin Oncol, 2014, 5(3): 478-494.
8. 杨华伟, 刘剑仑, 韦薇, 等. 乳腺癌术后Ⅰ期乳房重建 78 例报告. 广西医科大学学报, 2013, 30(2): 280-282.
9. 吴炅. 肿瘤整形技术在乳腺癌治疗中的应用. 临床外科杂志, 2016, 24(9): 660-662.
10. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015版). 中国癌症杂志, 2015, 25(9): 692-754.
11. 中华医学会整形外科学分会乳腺专业学组. 乳腺癌切除术后乳房再造临床指南. 中华肿瘤杂志, 2014, 36(11): 851-857.
12. 穆兰花, 辛敏强, 栾杰. 重建乳腺癌术后的研究现状及评价. 中华乳腺病杂志(电子版), 2011, 5(2): 49-52.穆兰花, 辛敏强, 栾杰.重建乳腺癌术后的研究现状及评价.中华乳腺病杂志（电子版）,2011,5（2）:49-52.
13. 何英, 邓宏武, 万能斌, 等. 现代医学模式影响下的乳腺癌手术方式递嬗. 医学与哲学, 2017, 38(4B): 27-30.
14. 陈颖, 陈嘉健, 陈嘉莹, 等. 中国乳腺癌术后乳房重建现况调查报告. 中华肿瘤杂志, 2014, 36(11): 851-857.
15. 熊凌云, 孙家明. 背阔肌肌皮瓣乳房重建的治疗现状与进展. 中国美容医学, 2010, 19(7): 1090-1093.
16. 卓睿. 即时扩展型背阔肌肌皮瓣乳房再造术常见失误及并发症探讨. 中华乳腺病杂志(电子版), 2010, 4(6): 692-700.
17. Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg, 2012, 39(5): 509-513.
18. Rifaat MA, Amin AA, Bassiouny M, et al. The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian J Plast Surg, 2008, 41(1): 24-33.
19. 卓睿. 乳腺癌即时扩展型背阔肌肌皮瓣乳房重建术中胸背神经的处理探讨. 广西中医学院学报, 2010, 13(4): 23-25.
20. Cha HG, Kang SG, Shin HS, et al. Does fibrin sealant reduce seroma after immediate breast reconstruction utilizing a latissimus dorsi myocutaneous flap? Arch Plast Surg, 2012, 39(5): 504-508.
21. Jagsi R, Jiang J, Momoh AO, et al. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg, 2016, 263(2): 219-227.
22. Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol, 2014, 5(3): 181-187.
23. Mohan AT, Saint-Cyr M. Anatomic and physiological fundamentals for autologous breast reconstruction. Gland Surg, 2015, 4(2): 116-133.
24. Kääriäinen M, Giordano S, Kauhanen S, et al. No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study. J Plast Reconstr Aesthet Surg, 2014, 67(8): 1106-1110.
25. González EG, Rancati AO. Skin-sparing mastectomy. Gland Surg, 2015, 4(6): 541-553.
26. Ismagilov A, Vanesyan A, Kamaletdinov I. Small refinements in breast reconstruction: a technique for inframammary fold creation. Gland Surg, 2017, 6(2): 132-140.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The application of latissimus dorsi myocutaneous flap in the breast reconstruction

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