The application of latissimus dorsi myocutaneous flap in the breast reconstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FENG Yueqing , ZHOU Yong , ZHAO Hui

Department of Head & Neck, Breast Surgery, Central Hospital of XinXiang, Xinxiang, Henan 453000, P. R. China;

Corresponding?author：

FENG Yueqing, Email: 15637359823@163.com

Keywords：

breast tumor; latissimus dorsi myocutaneous flap; breast reconstruction

DOI：

10.7507/1007-9424.201705034

Video：

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Objective To explore the value of the application of latissimus dorsi myocutaneous flap in the breast reconstruction. Methods The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235–490 min (mean of 325 min), the intraoperative blood loss was 200–260 mL (mean of 220 mL), and the hospitalization time was 18–33 d (mean of 23.6 d). The total operative time of patients who underwent delayed breast reconstruction was 325–550 min (mean of 355 min), the total intraoperative blood loss was 200–250 mL (mean of 220 mL), and the total hospitalization time was 27–45 d (mean of 32.5 d). The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% (30/36). There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3–60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function. Conclusion The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.

Citation： FENG Yueqing, ZHOU Yong, ZHAO Hui. The application of latissimus dorsi myocutaneous flap in the breast reconstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1365-1370. doi: 10.7507/1007-9424.201705034 Copy

1.	邵志敏, 余科達. 乳腺外科的發展趨勢. 中國普外基礎與臨床雜志, 2007, 14(3): 252-254.
2.	江澤飛, 李健斌. 精準醫學時代乳腺外科十個熱點問題思考. 中華普外科手術學雜志(電子版), 2016, 10(3): 192-196.
3.	Lee MA, Miteff KG. The scarless latissimus dorsi flap provides effective lower pole prosthetic coverage in breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(5): e147.
4.	Grotting JC, Robert J著; 范巨峰, 江華, 李洪生, 等譯. 麥卡錫整形外科學(第五分卷): 乳房(第3版). 北京: 人民衛生出版社, 2015: 318-327.
5.	Ahn S, Kim I, Kim J, 等著; 金光逸, 張晨, 王潔晴, 等譯. 現代韓國乳房整形術. 沈陽: 遼寧科學技術出版社, 2016: 375-384.
6.	共識專家討論組. 保留乳頭乳暈復合體乳房切除術的專家共識與爭議(2015 年版). 中國癌癥雜志, 2016, 26(5): 476-480.
7.	Munhoz AM, Montag E, Filassi JR, et al. Immediate nipple-areola-sparing mastectomy reconstruction: an update on oncological and reconstruction techniques. World J Clin Oncol, 2014, 5(3): 478-494.
8.	楊華偉, 劉劍侖, 韋薇, 等. 乳腺癌術后Ⅰ期乳房重建 78 例報告. 廣西醫科大學學報, 2013, 30(2): 280-282.
9.	吳炅. 腫瘤整形技術在乳腺癌治療中的應用. 臨床外科雜志, 2016, 24(9): 660-662.
10.	中國抗癌協會乳腺癌專業委員會. 中國抗癌協會乳腺癌診治指南與規范(2015版). 中國癌癥雜志, 2015, 25(9): 692-754.
11.	中華醫學會整形外科學分會乳腺專業學組. 乳腺癌切除術后乳房再造臨床指南. 中華腫瘤雜志, 2014, 36(11): 851-857.
12.	穆蘭花, 辛敏強, 欒杰. 重建乳腺癌術后的研究現狀及評價. 中華乳腺病雜志(電子版), 2011, 5(2): 49-52.穆蘭花, 辛敏強, 欒杰.重建乳腺癌術后的研究現狀及評價.中華乳腺病雜志（電子版）,2011,5（2）:49-52.
13.	何英, 鄧宏武, 萬能斌, 等. 現代醫學模式影響下的乳腺癌手術方式遞嬗. 醫學與哲學, 2017, 38(4B): 27-30.
14.	陳穎, 陳嘉健, 陳嘉瑩, 等. 中國乳腺癌術后乳房重建現況調查報告. 中華腫瘤雜志, 2014, 36(11): 851-857.
15.	熊凌云, 孫家明. 背闊肌肌皮瓣乳房重建的治療現狀與進展. 中國美容醫學, 2010, 19(7): 1090-1093.
16.	卓睿. 即時擴展型背闊肌肌皮瓣乳房再造術常見失誤及并發癥探討. 中華乳腺病雜志(電子版), 2010, 4(6): 692-700.
17.	Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg, 2012, 39(5): 509-513.
18.	Rifaat MA, Amin AA, Bassiouny M, et al. The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian J Plast Surg, 2008, 41(1): 24-33.
19.	卓睿. 乳腺癌即時擴展型背闊肌肌皮瓣乳房重建術中胸背神經的處理探討. 廣西中醫學院學報, 2010, 13(4): 23-25.
20.	Cha HG, Kang SG, Shin HS, et al. Does fibrin sealant reduce seroma after immediate breast reconstruction utilizing a latissimus dorsi myocutaneous flap? Arch Plast Surg, 2012, 39(5): 504-508.
21.	Jagsi R, Jiang J, Momoh AO, et al. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg, 2016, 263(2): 219-227.
22.	Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol, 2014, 5(3): 181-187.
23.	Mohan AT, Saint-Cyr M. Anatomic and physiological fundamentals for autologous breast reconstruction. Gland Surg, 2015, 4(2): 116-133.
24.	K??ri?inen M, Giordano S, Kauhanen S, et al. No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study. J Plast Reconstr Aesthet Surg, 2014, 67(8): 1106-1110.
25.	González EG, Rancati AO. Skin-sparing mastectomy. Gland Surg, 2015, 4(6): 541-553.
26.	Ismagilov A, Vanesyan A, Kamaletdinov I. Small refinements in breast reconstruction: a technique for inframammary fold creation. Gland Surg, 2017, 6(2): 132-140.

1. 邵志敏, 余科達. 乳腺外科的發展趨勢. 中國普外基礎與臨床雜志, 2007, 14(3): 252-254.
2. 江澤飛, 李健斌. 精準醫學時代乳腺外科十個熱點問題思考. 中華普外科手術學雜志(電子版), 2016, 10(3): 192-196.
3. Lee MA, Miteff KG. The scarless latissimus dorsi flap provides effective lower pole prosthetic coverage in breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(5): e147.
4. Grotting JC, Robert J著; 范巨峰, 江華, 李洪生, 等譯. 麥卡錫整形外科學(第五分卷): 乳房(第3版). 北京: 人民衛生出版社, 2015: 318-327.
5. Ahn S, Kim I, Kim J, 等著; 金光逸, 張晨, 王潔晴, 等譯. 現代韓國乳房整形術. 沈陽: 遼寧科學技術出版社, 2016: 375-384.
6. 共識專家討論組. 保留乳頭乳暈復合體乳房切除術的專家共識與爭議(2015 年版). 中國癌癥雜志, 2016, 26(5): 476-480.
7. Munhoz AM, Montag E, Filassi JR, et al. Immediate nipple-areola-sparing mastectomy reconstruction: an update on oncological and reconstruction techniques. World J Clin Oncol, 2014, 5(3): 478-494.
8. 楊華偉, 劉劍侖, 韋薇, 等. 乳腺癌術后Ⅰ期乳房重建 78 例報告. 廣西醫科大學學報, 2013, 30(2): 280-282.
9. 吳炅. 腫瘤整形技術在乳腺癌治療中的應用. 臨床外科雜志, 2016, 24(9): 660-662.
10. 中國抗癌協會乳腺癌專業委員會. 中國抗癌協會乳腺癌診治指南與規范(2015版). 中國癌癥雜志, 2015, 25(9): 692-754.
11. 中華醫學會整形外科學分會乳腺專業學組. 乳腺癌切除術后乳房再造臨床指南. 中華腫瘤雜志, 2014, 36(11): 851-857.
12. 穆蘭花, 辛敏強, 欒杰. 重建乳腺癌術后的研究現狀及評價. 中華乳腺病雜志(電子版), 2011, 5(2): 49-52.穆蘭花, 辛敏強, 欒杰.重建乳腺癌術后的研究現狀及評價.中華乳腺病雜志（電子版）,2011,5（2）:49-52.
13. 何英, 鄧宏武, 萬能斌, 等. 現代醫學模式影響下的乳腺癌手術方式遞嬗. 醫學與哲學, 2017, 38(4B): 27-30.
14. 陳穎, 陳嘉健, 陳嘉瑩, 等. 中國乳腺癌術后乳房重建現況調查報告. 中華腫瘤雜志, 2014, 36(11): 851-857.
15. 熊凌云, 孫家明. 背闊肌肌皮瓣乳房重建的治療現狀與進展. 中國美容醫學, 2010, 19(7): 1090-1093.
16. 卓睿. 即時擴展型背闊肌肌皮瓣乳房再造術常見失誤及并發癥探討. 中華乳腺病雜志(電子版), 2010, 4(6): 692-700.
17. Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg, 2012, 39(5): 509-513.
18. Rifaat MA, Amin AA, Bassiouny M, et al. The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian J Plast Surg, 2008, 41(1): 24-33.
19. 卓睿. 乳腺癌即時擴展型背闊肌肌皮瓣乳房重建術中胸背神經的處理探討. 廣西中醫學院學報, 2010, 13(4): 23-25.
20. Cha HG, Kang SG, Shin HS, et al. Does fibrin sealant reduce seroma after immediate breast reconstruction utilizing a latissimus dorsi myocutaneous flap? Arch Plast Surg, 2012, 39(5): 504-508.
21. Jagsi R, Jiang J, Momoh AO, et al. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg, 2016, 263(2): 219-227.
22. Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol, 2014, 5(3): 181-187.
23. Mohan AT, Saint-Cyr M. Anatomic and physiological fundamentals for autologous breast reconstruction. Gland Surg, 2015, 4(2): 116-133.
24. K??ri?inen M, Giordano S, Kauhanen S, et al. No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study. J Plast Reconstr Aesthet Surg, 2014, 67(8): 1106-1110.
25. González EG, Rancati AO. Skin-sparing mastectomy. Gland Surg, 2015, 4(6): 541-553.
26. Ismagilov A, Vanesyan A, Kamaletdinov I. Small refinements in breast reconstruction: a technique for inframammary fold creation. Gland Surg, 2017, 6(2): 132-140.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The application of latissimus dorsi myocutaneous flap in the breast reconstruction

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