Volumetric change of the latissimus dorsi muscle after postoperative chemotherapy and radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap: final results from serial studies

Abstract

Background Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap.Methods This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance.Results The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05).Conclusions Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction

“…Previous studies have reported that muscle denervation causes atrophy 6,16 . However, to the best of our knowledge, no study has reported the measurement of the degree of atrophy in reinnervated free muscle transfer.…”

“…Previous studies have reported that muscle denervation causes atrophy. 6,16 However, to the best of our knowledge, no study has reported the measurement of the degree of atrophy in reinnervated free muscle transfer. To accurately compare the volume change of reinnervated and denervated muscles, it is necessary to compare the conventional ALT MC flap without neurorrhaphy and the dynamic ALT flap.…”

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

“…There are various opinions about the cause of the decrease in the volume of the flap over time. In case of muscle flap, atrophy is known to occur because of denervation, 2 but in case of fasciocutaneous flap, transitional ischemic effect has been suggested as the cause 1,9 . In addition, it is hypothesized that the relief of edema and inflammation after surgery also affects volume reduction.…”

“…However, the change in flap volume is an unavoidable phenomenon over time. 1,2 As most of the musculature of the tongue is resected in total tongue reconstruction, there are some studies focusing on the reconstruction of volume and function. 3,4 However, in partial tongue reconstruction, some muscles and functions remain; therefore, a small flap is mainly used, and interest in changes after surgery is relatively low.…”

“…Optimal volume restoration is important in case of hemi-tongue reconstruction as well as in total tongue reconstruction in terms of functional maintenance. However, the change in flap volume is an unavoidable phenomenon over time 1,2 . As most of the musculature of the tongue is resected in total tongue reconstruction, there are some studies focusing on the reconstruction of volume and function 3,4 .…”