Tips and Tricks to Improve Clinical and Aesthetic Outcomes in Latissimus Dorsi Flap Breast Reconstruction

Laporta, Rosaria; Sorotos, Michail; Longo, Benedetto; Pompeo, Fabio Santanelli di

doi:10.1055/s-0037-1601379

Cited by 9 publications

(6 citation statements)

References 31 publications

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Section: Discussionmentioning

confidence: 99%

“…We consider it a viable option for secondary reconstruction and for immediate reconstruction in case of prior irradiated small/medium size breast, superficial tumors that require wide skin excision and the presence of scars that could compromise mastectomy flaps.Moreover, TDAP flap it is not characterized by the loss of volume due to muscular atrophy, which instead characterizes the LD muscle. 26 Obviously, when there are no reliable perforators for a TDAP harvesting, changing from a perforator flap to a skin Table 2 Primary outcome (DASH score) and perioperative secondary outcomes in the whole cohort and with differentiation between LD and TDAP intervention groups…”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Brambilla

Parisi

Gatto

et al. 2021

J Reconstr Microsurg

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Introduction In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function. Methods We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). Results The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, p = 0.047. Table 3). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant (p = 0.049). Conclusions TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Brambilla

Parisi

Gatto

et al. 2021

J Reconstr Microsurg

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“…Поэтому укрытие имплантата широчайшей мышцей спины в комбинации с большой грудной мышцей позволяет добиться лучших эстетических результатов, чем укрытие одной лишь широчайшей мышцей спины. такая методика подтверждается и R. Laporta et al (2017) [12]. В своем исследовании авторы сообщают о 418 успешных реконструкциях с помощью тДЛ, особенно, если удавалось полностью закрыть протез лоскутом.…”

Section: материалы и методыunclassified

Experience of Reconstruction of the Breast With the Use of Thoracodorsal Flap

Krivorotko¹,

Семиглазов²,

Belyaev³

et al. 2018

Problems in oncology

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Purpose: To analyze the results of treatment and the quality of medical care for breast cancer patients with breast reconstruction using thoracodorsal flap (TDF). Material and methods: The study was conducted on the basis of the N.N. Petrov National Medical Research Center of Oncology at the Department of Breast Tumors for the period 2016-2017. When using the reconstruction of the breast with the help of TDF the feature was the complete intersection of the muscle in the anterior-axillary line before closing the defect of the breast tissue but with the preservation of the thoracodorsal vascular sheaf. Surgical treatment was provided to 67 patients with breast cancer including after neoadjuvant therapy. Results: One-time reconstruction was performed in 16 (23.8%) patients under the organ-preserving surgery, mastectomy in two (2.9%) patients and mastectomy with implant placement in 27 (40.2%) patients. Delayed reconstruction of the breast: TDF in combination with the implant - 20 (29.8%), the use of TDF without an implant - 2 (2.9%) patients. Complications were observed in 6 (8.9%) patients. Conclusion: Reconstruction of the breast with TDF is the method of choice and priority for patients who underwent radiation therapy with a lack of integumentary tissues to cover the implant. TDF is a «good» plastic material and could be used in patients with severe defect of breast shape after organ-preserving surgery and mastectomy. TDF is characterized by a low incidence of complications. The use of TDF does not worsen the rehabilitation of patients and does not shift the timing of adjuvant treatment.

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“…8 The musculocutaneous approach can also serve aesthetical demands, for example, in breast reconstruction. 9…”

mentioning

confidence: 99%

Mapping of Thoracodorsal Artery Perforators: Accuracy of Thermography and Handheld Doppler

Illg,

Heinzel,

Denzinger

et al. 2024

J Reconstr Microsurg

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Background The versatile musculocutaneous latissimus dorsi flap and the thoracodorsal artery (TDA) perforator flap have developed into indispensable approaches in reconstructive surgery. While the anatomy of the TDA is consistent, the skin perforators vary in location and course. Dynamic infrared thermography (DIRT) recently gained popularity for perforator identification; however, its use and accuracy in thoracodorsal artery perforator (TDAP) mapping is yet to be determined. Methods TDAPs were visualized in 50 cases by DIRT. Based on the thermographic hotspots, the corresponding perforators were then identified by color duplex ultrasound (CDU) and handheld Doppler in a blinded fashion by two separate examiners. Results The midpoint of all perforator fascia passages was localized 99.7 mm caudal and 13.5 mm medial of the posterior axillary fold. The positive predictive value of perforator identification by dynamic infrared thermography was 86.5% and the correlating perforator fascia passage was 9.9 ± 5.8 mm from the hotspot midpoint, with a maximum of 29 mm. The positive predictive value of perforator identification by handheld Doppler was 95% and the signal was 7.2 ± 5.1 mm from the perforator fascia passage. Conclusion DIRT precisely localizes TDAPs. The fusion with CDU combines both modalities' advantages. The combination with handheld Doppler is a fast way of perforator imaging, decreasing the handheld Dopplers' high false positive rate.

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Tips and Tricks to Improve Clinical and Aesthetic Outcomes in Latissimus Dorsi Flap Breast Reconstruction

Cited by 9 publications

References 31 publications

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Experience of Reconstruction of the Breast With the Use of Thoracodorsal Flap

Mapping of Thoracodorsal Artery Perforators: Accuracy of Thermography and Handheld Doppler

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