Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Lei ¹ , SONG Dajiang ² , SONG Aili ¹ ,  LI Zan ² , ZHOU Bo ² , LÜ Chunliu ² , TANG Yuanyuan ²

1. Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250014, P.R.China;
2. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Locally advanced breast cancer; latissimus dorsi myocutaneous flap; bilobed flap; chest wall reconstruction

DOI：

10.7507/1002-1892.202102049

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Objective To explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.Methods Between January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.Results In antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ²=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).Conclusion The modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.

Citation： WANG Lei, SONG Dajiang, SONG Aili, LI Zan, ZHOU Bo, LÜ Chunliu, TANG Yuanyuan. Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1172-1176. doi: 10.7507/1002-1892.202102049 Copy

1.	冯自豪, 张勇, 杨燕文, 等. 巨大局部晚期乳腺癌的手术和修复. 中华乳腺病杂志 (电子版), 2010, 4(6): 701-711.
2.	Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: a 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
3.	Bakri K, Mardini S, Evans KK, et al. Workhorse flaps in chest wall reconstruction: the pectoralis major, latissimus dorsi, and rectus abdominis flaps. Semin Plast Surg, 2011, 25(1): 43-54.
4.	宋达疆, 李赞, 周晓, 等. 不同形式横行腹直肌肌皮瓣在乳房再造和胸壁溃疡修复中的应用经验教训及对策. 中国医师杂志, 2018, 20(4): 511-516.
5.	宋达疆, 李赞, 周晓, 等. 局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复. 中华整形外科杂志, 2018, 34(8): 630-635.
6.	宋达疆, 李赞, 周晓, 等. 胸壁肿瘤术后胸壁复杂缺损修复重建策略. 中华胸心血管外科杂志, 2017, 33(3): 164-167.
7.	宋达疆, 毛煌兴, 李赞, 等. 侧胸带蒂胸外侧动脉穿支皮瓣的解剖观察及其在保乳术乳房重建中的临床应用. 中华解剖与临床杂志, 2020, 25(1): 37-42.
8.	Munhoz AM, Montag E, Arruda E, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg, 2011, 127(6): 2186-2197.
9.	Durkin AJ, Pierpont YN, Patel S, et al. An algorithmic approach to breast reconstruction using latissimus dorsi myocutaneous flaps. Plast Reconstr Surg, 2010, 125(5): 1318-1327.
10.	Kim JT, Kim SW, Youn S, et al. What is the ideal free flap for soft tissue reconstruction? A ten-year experience of microsurgical reconstruction using 334 latissimus dorsi flaps from a universal donor site. Ann Plast Surg, 2015, 75(1): 49-54.
11.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
12.	Boonipat T, Ji L, Manrique OJ, et al. Combined bipedicled latissimus dorsi and groin flap for anterior chest wall reconstruction. BMJ Case Rep, 2019, 12(5): e227372. doi: 10.1136/bcr-2018-227372.
13.	Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
14.	Schneider WJ, Hill HL, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg, 1977, 30(4): 277-281.
15.	Arnold PG, Pairolero PC. Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg, 1996, 98(5): 804-810.
16.	Bonomi S, Salval A, Sorbi F, et al. Chest wall reconstruction for locally advanced breast cancer with the V-Y thoracoabdominal perforator flap. Plast Reconstr Surg, 2012, 129(2): 361e-362e.
17.	Micali E, Carramaschi FR. Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg, 2001, 107(6): 1382-1390.

1. 冯自豪, 张勇, 杨燕文, 等. 巨大局部晚期乳腺癌的手术和修复. 中华乳腺病杂志 (电子版), 2010, 4(6): 701-711.
2. Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: a 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
3. Bakri K, Mardini S, Evans KK, et al. Workhorse flaps in chest wall reconstruction: the pectoralis major, latissimus dorsi, and rectus abdominis flaps. Semin Plast Surg, 2011, 25(1): 43-54.
4. 宋达疆, 李赞, 周晓, 等. 不同形式横行腹直肌肌皮瓣在乳房再造和胸壁溃疡修复中的应用经验教训及对策. 中国医师杂志, 2018, 20(4): 511-516.
5. 宋达疆, 李赞, 周晓, 等. 局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复. 中华整形外科杂志, 2018, 34(8): 630-635.
6. 宋达疆, 李赞, 周晓, 等. 胸壁肿瘤术后胸壁复杂缺损修复重建策略. 中华胸心血管外科杂志, 2017, 33(3): 164-167.
7. 宋达疆, 毛煌兴, 李赞, 等. 侧胸带蒂胸外侧动脉穿支皮瓣的解剖观察及其在保乳术乳房重建中的临床应用. 中华解剖与临床杂志, 2020, 25(1): 37-42.
8. Munhoz AM, Montag E, Arruda E, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg, 2011, 127(6): 2186-2197.
9. Durkin AJ, Pierpont YN, Patel S, et al. An algorithmic approach to breast reconstruction using latissimus dorsi myocutaneous flaps. Plast Reconstr Surg, 2010, 125(5): 1318-1327.
10. Kim JT, Kim SW, Youn S, et al. What is the ideal free flap for soft tissue reconstruction? A ten-year experience of microsurgical reconstruction using 334 latissimus dorsi flaps from a universal donor site. Ann Plast Surg, 2015, 75(1): 49-54.
11. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
12. Boonipat T, Ji L, Manrique OJ, et al. Combined bipedicled latissimus dorsi and groin flap for anterior chest wall reconstruction. BMJ Case Rep, 2019, 12(5): e227372. doi: 10.1136/bcr-2018-227372.
13. Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap—anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2123-2127.
14. Schneider WJ, Hill HL, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg, 1977, 30(4): 277-281.
15. Arnold PG, Pairolero PC. Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg, 1996, 98(5): 804-810.
16. Bonomi S, Salval A, Sorbi F, et al. Chest wall reconstruction for locally advanced breast cancer with the V-Y thoracoabdominal perforator flap. Plast Reconstr Surg, 2012, 129(2): 361e-362e.
17. Micali E, Carramaschi FR. Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg, 2001, 107(6): 1382-1390.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients

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