Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction (original) (raw)
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Latissimus Dorsi Flap: A Winning Hand for Breast Reconstruction Salvage
2019
BACKGROUND There are several methods for primary breast reconstruction following oncologic resection, including alloplastic and autologous-based reconstruction. Major complications that can lead to re-operation and reconstruction failure occur in up to 25% of the patients and necessitate salvage procedures. OBJECTIVES To present the authors' experience using a pedicled latissimus dorsi (LD) flap for the salvage of complicated and impending failed breast reconstruction. METHODS A retrospective cohort study was conducted of all patients who underwent breast reconstruction salvage by means of an LD flap in our institution during a 5-year period. Demographic, oncologic, surgical, and postoperative data were collected and analyzed. RESULTS Seventeen patients underwent breast reconstruction salvage with the LD flap. Fourteen patients had alloplastic reconstruction and three patients had autologous reconstruction. Postoperative complications included wound infection in three patients, ...
Plastic & Reconstructive Surgery, 1999
Background: Refinements made in latissimus dorsi breast reconstruction have improved the aesthetic appearance of the breast without changing the donorsite location. The optimal location for donor-site placement, from a patient's perspective, is still unknown. The purpose of this study was to assess women's preference for the latissimus dorsi donor-site location; the reasons for donor-site choice; and the correlation between donor-site location preference and factors such as, age, body mass index, body image, and clothing options. Methods: Two hundred fifty women between the ages of 20 and 80 years were surveyed. Participants analyzed patients' pictures and ranked the scar locations from most desirable to least desirable. The reason for preference and additional factors were assessed. The data were then collected and analyzed using contingency tables with p Ͻ 0.005. Results: The low and middle transverse donor sites were the most preferred sites, 54 percent and 22 percent, respectively. The most common reasons for choosing a donors site were ability to conceal the scar in a low-back top and contour improvement. Women younger than 50 years were more concerned about the ability to conceal the scar (64 percent). Women older than 50 years were focused on contour improvement (40 percent) and concealing the scar while clothed (42 percent) (p Ͻ 0.05). No direct correlation with age, body mass index, body image, or clothing options was seen. Conclusions: Women overwhelmingly prefer the low and middle transverse scar locations. Physicians should consider using these locations primarily in suitable patients, as this may improve overall patient satisfaction following breast reconstruction. (Plast. Reconstr. Surg. 126: 358, 2010.)
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012
The latissimus dorsi (LD) flap and its extended version are popular choices for reconstruction of the breast after mastectomy. Donor site complications such as seroma and wound dehiscence are relatively common with these flaps; however, severe donor site healing problems requiring major surgical intervention are not reported in the literature. We report three breast reconstructions with extended LD flaps in which the patients had severe healing problems of the donor site. Simpler, routine measures failed and free tissue transfer was necessary to achieve healing.
Breast reconstruction with the latissimus dorsi musculocutaneous flap
Clinics in plastic surgery, 1984
1. Clin Plast Surg. 1984 Apr;11(2):287-302. Breast reconstruction with the latissimus dorsi musculocutaneous flap. Cohen BE, Cronin ED. For breast reconstruction the latissimus flap provides a safe and relatively simple road whose landmarks are familiar to plastic surgeons. ...
The Use of Latissimus Dorsi Mini-Flap in Partial Breast Reconstruction Citation
Introduction: The cosmetic drawbacks of breast conserving surgery are asymmetry, nipple or skin retraction, and volume loss with unsatisfactory cosmetic outcome. The principle of Latissimus dorsi mini-flap (LDMF) is to use part of the Latissimus dorsi (LD) muscle as volume replacement to large breast defect up to 20 -30 % of the breast volume.
Short-Scar Latissimus Dorsi With a Lateral Approach: A Game Changer in Breast Reconstruction?
Aesthetic Surgery Journal, 2021
Background In delayed breast reconstruction, the thoraco-mammary cutaneous tissue often shows residual damage from radiotherapy. The fragility of this tissue is associated with a risk of skin necroses of approximately 8% when dissection is performed by reopening of the mastectomy scar. Objectives The objective of this study was to adapt the technique of short-scar latissimus dorsi flap surgery with an abdominal advancement flap employing a lateral approach only avoiding re-incision of the mastectomy scar. Methods In this retrospective study, the authors performed 150 reconstructions in 146 patients to assess the safety and effectiveness of the short-scar latissimus dorsi technique with lateral approach. The primary outcome was the occurrence of postoperative skin necrosis of the thoraco-mammary area. Results Of the 150 delayed breast reconstruction procedures performed, none showed skin necrosis of the thoraco-mammary area, and a positive effect on skin trophicity of this area was o...
Latissimus Dorsi Donor-Site Morbidity
Annals of Plastic Surgery, 2012
Seroma formation has been shown to be a multifactorial process in part due to dead space and the formation of raw surfaces, which produce large quantities of serous exudate. The purpose of this study is to evaluate the effect of quilting/progressive tension sutures (to reduce dead space) and fibrin sealant (to seal the raw surface) in combination on the seroma rate and length of drain placement in patients undergoing latissimus dorsi breast reconstruction. A retrospective review of 43 patients undergoing latissimus dorsi flap breast reconstruction was performed. The patients were divided into 2 groups: quilting sutures alone versus those with quilting sutures and fibrin sealant. Data regarding age, body mass index, smoking history, timing of reconstruction, type of breast surgery, radiation history, complications, length of drain placement, use of fibrin glue, and use of quilting/progressive tension sutures were collected for each patient. Results were analyzed statistically using unpaired t tests (P G 0.05). The quilting group included 19 patients with 24 donor sites. The mean drain placement duration was 21.5 days (range, 9Y69 days). One patient in 19 developed a seroma, which was treated and resolved with aspiration. The seroma rate for the quilting only group was 5%. The quilting and sealant group included 23 patients with 26 donor sites. The quilting and sealant group had a mean duration of drain placement of 13.9 days (range, 6Y38 days). This was a statistically reduced length of drainage (P = 0.04) compared with quilting only. The quilting and sealant group had 1 patient in 23 develop a seroma with a rate of 4% which compared with quilting only was not statistically significant (P = 0.4). The combination of quilting sutures and fibrin sealant directed at the 2 main mechanisms of seroma formation, (dead space and serous exudate, respectively) can decrease the duration of postoperative drain placement and does maintain low seroma rates.
Annals of Medicine and Surgery, 2020
Background: The latissimus dorsi (LD) flap is one of the most popular techniques in breast reconstruction. Although numerous studies have not shown functional impairment of the shoulder after surgery, other studies have reported significant functional impairment, especially after extended LD flap reconstruction. The present study compared functional deficit and shoulder movement between extended LD and LD flap reconstruction. Materials and methods: Between December 2015 and May 2018, this study enrolled 31 patients undergoing LD flap reconstruction. Data on patient demographics, operative details, morbidities, and degree of shoulder movement were collected. Outcomes were compared between the extended LD and LD flap groups. Results: Twenty-one women and 10 women underwent LD flap and extended LD flap reconstruction, respectively. The median patient age was 43 years. No demographic data differed between groups. Seroma, especially around the back incision, was the most common complication (90.5% in the LD flap and 90% in the extended LD group). Five patients in the LD flap group and one patient in the extended LD flap group showed decreased shoulder range of motion (ROM) at 6 months post-operation. Only one patient in the LD flap group showed impairment based on American Shoulder and Elbow Surgeons Shoulder Score (ASES). The results did not differ significantly between groups; however, the LD flap group showed faster functional recovery. Conclusion: LD flap reconstruction can be performed with a very low impact on shoulder function. We observed a slightly decreased ROM for both LD flap techniques, with no impact on functional outcome.