Using KISS Flaps in a Chest Wall Reconstruction After Mastectomy for Locally Advanced Breast Cancer: A New Technique

Abstract

This study described a technique for the reconstruction of large lateral thoracic defects after local advanced breast cancer resection that allows for complete cover of the defect and primary closure of the donor site. The authors performed reconstruction using the newly designed KISS flap in 2 women for coverage of their large skin defect (15 × 13 cm each) following mastectomies with extensive tissue resection. The KISS flap consisting of 2 skin islands (marked Flap A and Flap B; 15 × 6 cm each) was designed and transferred to the thoracic defect through the subcutaneous tunnel, and based on the same vessel. The flap covered properly without causing excessive tension and allowed primary closure of chest wound and donor defect. The security it brings is comparable with that of classical radical mastectomy, and its success rate is similar to that of single skin flap transplantation. Compared with the conventional pedicled latissimus-dorsi-musculocutaneous flap, we believe that the donor zone tension decreases, wherein the KISS flaps can reduce the incidence of incision dehiscence and nonhealing complications to some extent. The study reported good results from this technique and discussed the techniques that referenced previous reports.

Mini-Shaped Kiss Flap Design for Palmar and Digital Soft Tissue Resurfacing

“…Taking into account surgeons' experiences and inspirations, the kiss concept has indicated great versatility in different kinds of flaps including the deep inferior epigastric artery perforator flap, the anterolateral thigh flap, the latissimus dorsi flap, the posterior interosseous artery perforator flap, the medial sural artery perforator flap, and the radial forearm flap. [9][10][11][12][13][14] Interestingly, as the original intention was to maximize reconstructive abilities while minimizing donor-site morbidity, the kiss flap concept tended to be applied only for those large-dimension flaps with closure problems.…”

“…To date, the technique has been used in the deep inferior epigastric artery perforator flap, posterior interosseous artery perforator flap, anterolateral thigh flap, radial forearm flap, medial sural artery perforator flap, and latissimus dorsi flap. [9][10][11][12][13][14] In this study, we described the use of the mini-shaped kiss flap for palmar and digital resurfacing to illustrate how we balanced the optimal surgical outcome with minimized donor-site morbidity.…”

“Superman” Latissimus Dorsi Flap for Breast Reconstruction: A Technical Innovation for Covering Extensive Mastectomy Defect

“…The skin paddles were later sutured together to form a complete circle and cover the defect. The donor site was closed primarily [6]. The fleur-de-lis pattern described by Ciudad et al for extensive soft tissue defects utilizes a modified skin paddle with medial and lateral extensions just above the posterior superior iliac crest [7].…”

“…Various modifications in the design of harvested LD flap skin paddles have been proposed in the literature to overcome the limitation of the size of the skin paddle [5][6][7]. We report a case of carcinoma breast with an extensive post-mastectomy defect, resurfaced with a pedicled LD myocutaneous flap with an S-shaped skin paddle, allowing primary closure of the donor site.…”

Pedicled Latissimus Dorsi Kiss Flap for the Reconstruction of Large Chest Wall Defect After Mastectomy

“…Reconstruction of the defect on the chest wall after mastectomy had been problematic for breast surgeons. The latissimus dorsi kiss flap was based on this concept to improve the traditional latissimus dorsi musculocutaneous flap [2][3][4] and encompassed two semicircle flaps that were supplied by the same blood vessel. After cutting, two semicircle flaps were pulled along the subcutaneous tunnel to the recipient area and spliced to repair the defect.…”