Background We conducted a prospective cohort study to evaluate effective techniques for breast reconstruction after partial mastectomy due to breast cancer. Determining the method of reconstruction is often difficult as it depends on the location of the cancer and the amount of tissue excised.. Here, we present a new technique, using the vertical latissimus dorsi (LD) flap, that can be used in all partial mastectomies and can almost conceal scarring. We also compared these results to those of the mini LD flap. Methods We analyzed the data of a total of 50 and 47 patients, who underwent breast reconstruction with the mini LD flap and the vertical LD flap, respectively. Immediately after tumor excision, breast reconstruction was initiated. The skin flap for vertical LD was designed in a planarian shape, such that it may be hidden as much as possible and minimize bulging during closure, and the LD muscle flap was designed with a sufficient distance in the inferior direction. Results Our finding showed that the vertical LD flap group required significantly less total operation time than the mini LD flap group. While the mini-LD flap resulted in a scar that was difficult to conceal, the donor site scar of the vertical LD flap could not be seen easily, and no scar was visible on the back. Conclusions The vertical LD flap is useful for partial breast reconstruction, in all breast regions requires a rather small volume of the flap. Moreover, recovery was relatively fast with high patient satisfaction.
BACKGROUND The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest CT angiography. PATIENTS AND METHODS We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. RESULTS 700 blood vessels were classified according to the KNUPS TDA classification, 388 (185 Rt. and 203 Lt.), 126 (64 Rt. and 62 Lt.), 91 (49 Rt. and 42 Lt.), 57 (27 Rt. and 30 Lt.), and 38 (25 Rt. and 13 Lt.) vessels were classified as Type I, II, III, IV, and V, respectively. Among 350 patients, 205 patients showed matching types for Lt. and Rt. vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with Type I, II, III, IV, and V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with Types I+II, I+III, I+IV, I+V, II+III, II+IV, II+V, III+IV, III+V, and IV+V, respectively. CONCLUSIONS While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.
BackgroundWe conducted a prospective cohort study to evaluate effective technique for breast reconstruction after partial mastectomy due to breast cancer. Depending on the location of the cancer and the amount excised, what method to employ is often difficult to determine. Here, we present a new technique, using the vertical LD flap, that can be used in all partial mastectomies and can almost hide scarring. We also compare these results to the mini-LD flap. MethodsWe analyzed a total of 50 and 47 patients, who underwent breast reconstruction with the mini-LD flap and the vertical LD flap, respectively. Immediately after cancer excision, work on reconstruction began. The skin flap for vertical LD was designed in a planaria shape, such that it may be hidden as much as possible and minimize bulging during closure, and the LD muscle flap was designed with a sufficient distance in the inferior direction.ResultsOur finding showed that the vertical LD flap group required significantly less total operation time than the mini-LD flap group. While the mini-LD flap resulted in a scar that was difficult to hide, the donor site scar of the vertical LD flap could not be seen easily, and no scar was visible on the back. ConclusionsThe vertical LD flap is capable of all partial breast reconstruction, can reconstruct defects in all breast regions, and requires a rather small volume of the flap. The patients show relatively fast recovery after the operation and high patient satisfaction.
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