Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap

Abstract

The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

Latissimus Dorsi Myocutaneous Extended Flap in the Reconstruction of Large Chest Wall Defects after Extensive Resections in Breast Pathology

“…In view of this experience, locally advanced carcinoma was initially classified as inoperable when there were complications such as extensive skin edema or satellite lesions, intercostal nodules, edema of the arm, supraclavicular metastasis or inflammatory cancer, ulceration, edema of the skin, fixation to pectoralis muscle, and bulky axillary adenopathy, which are poor prognosis factors and not necessarily un-resectability criteria. The role of reconstructive surgery in the treatment of locally advanced cancer is a topic of increasing interest owing to the development of innovative techniques that allow the surgeon to perform broad oncological resections, which previously would have been regarded as being unfeasible 24 . Myocutaneous, skin, or entirely muscle flaps have been shown to be acceptable alternatives for reconstruction in large defects 18 .…”

“…The thoracodorsal vessels normally provide the blood supply of the pedicle for the latissimus dorsi flap, usually allowing for a large muscle portion to be mobilized. However, the size of the skin portion is often not too large, and the skills to close the donor site dictates the size of the flap; therefore, the usual size of the skin is generally not larger than 10 cm in the described classic techniques 17,23,24 . For this reason, the classic technique has been modified at the FUCAM Institute of Breast Diseases in order to obtain larger skin flaps that allow for large chest wall defects to be reconstructed after breast cancer-related resections.…”

Value of Porous Titanium Alloy Plates for Chest Wall Reconstruction after Resection of Chest Wall Tumors

“…However, the resection range should be properly enlarged to such tumors as desmoids, chondroma and osteoclastoma, or be resolved as in malignant tumors, though with benign pathological examinations (Errani et al, 2010;Nieuwenhuis et al, 2011). Chest wall resection can bring about different degrees of chest wall defects, which need to be repaired and reconstructed (Munhoz et al, 2011;Maeda et al, 2014).…”

Colgajo miocutáneo extendido de dorsal ancho en la reconstrucción de grandes defectos de la pared torácica posterior a resecciones extensas en enfermedad mamaria

“…Ante esta experiencia, el carcinoma localmente avanzado se clasificó inicialmente como inoperable cuando se presentaban condiciones como edema de piel extenso o lesiones satélites, nódulos intercostales, edema en el brazo, metástasis supraclavicular o irresecabilidad. El rol de la cirugía reconstructiva en el tratamiento del cáncer localmente avanzado es un tema con interés creciente, debido al desarrollo de técnicas innovadoras, que permiten al cirujano realizar resecciones oncológicas amplias que anteriormente se hubiesen considerado inoperables 24 . Se ha demostrado que en los grandes defectos los colgajos miocutáneos, cutáneos o totalmente musculares son alternativas aceptables para la reconstrucción 18 .…”

“…El colgajo de dorsal ancho se usa ampliamente en la reconstrucción de la pared torácica, principalmente en pacientes con cáncer de mama 22 . Los vasos toracodorsales habitualmente proveen la irrigación del pedículo para el colgajo dorsal, permitiendo usualmente movilizar una gran porción muscular, pero el tamaño de la porción dérmica no suele ser muy amplio y la habilidad para cerrar el sitio donador dicta el tamaño del colgajo, por lo que generalmente el tamaño usual de piel no es mayor a 10 cm en las técnicas clásicas descritas 17,23,24 . Por esta razón, en el Instituto de Enfermedades de la Mama FUCAM se ha modificado la técnica clásica descrita con la finalidad de obtener islas cutáneas de mayor tamaño que permitan reconstruir grandes defectos de la pared torácica de forma posterior a resecciones por cáncer de mama.…”