Functional sequelae following bilateral mastectomy and immediate reconstruction with Latissimus Dorsi flap: Medium-term follow-up

Background: The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm. Methods: A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures. Results: A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm2. Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap. Conclusions: The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.

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Latissimus dorsi myocutaneous reconstruction: a study of long-term outcomes in a district general hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0311 ◽

2016 ◽

Vol 98 (8) ◽

pp. 574-577 ◽

Cited By ~ 3

Author(s):

C Kallaway ◽

A Humphreys ◽

N Laurence ◽

R Sutton

Keyword(s):

General Hospital ◽

Latissimus Dorsi ◽

Capsular Contracture ◽

District General Hospital ◽

Latissimus Dorsi Flap ◽

Protective Mechanism ◽

Term Outcome ◽

Long Term Outcome

INTRODUCTIONThe aim of this study was to evaluate the long-term outcome and durability of both autologous and implant-assisted latissimus dorsi reconstruction in a district general hospital over a 10-year follow-up period.METHODSA prospective cohort study was carried out using a detailed database of all latissimus dorsi flap reconstructions performed by a single consultant surgeon between 2003 and 2013 at the Royal United Hospital, Bath. The long-term outcome following reconstruction was assessed by analysing all episodes of ‘reconstruction-specific’ operations required from 6 months after the initial surgery.RESULTSThe study included 110 patients with latissimus dorsi flap reconstructions, 21 autologous and 95 implant-assisted. Radiotherapy was given to 27 patients with reconstructed flaps. Mean follow-up was 69 months. Further reconstruction-specific surgery was needed in 27 (23%) cases, with 5 of these being post-radiotherapy flaps. Implant-related surgery was the most common reason for further surgery. Complications of the implant itself made up 52% of these cases, chronic sepsis being the most common. The rate of symptomatic capsular contracture requiring further surgery was 4.2%. Of these, one of four patients had undergone radiotherapy.DISCUSSIONIn our institution, latissimus dorsi reconstruction is durable and safe over the long term, with limited need for further substantial intervention to maintain a good outcome from the initial reconstruction. Autologous flaps were less likely to require further surgery over the long term compared with implant-based reconstructions. The low rate of symptomatic capsular contracture may be due to the protective mechanism provided by the extended harvest flap used.

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Evaluation of Immediate Reconstruction with Mini latissimus Dorsi flap(MLDF) After Conservative Breast Surgery(CBS).

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2007.07.146 ◽

2007 ◽

Vol 33 (9) ◽

pp. 1133-1133

Author(s):

A ELAFFANDI ◽

H KHALIFA ◽

H KHALIL ◽

H ABOUELKASSEM ◽

M ELSHERBEENY ◽

...

Keyword(s):

Latissimus Dorsi ◽

Breast Surgery ◽

Latissimus Dorsi Flap ◽

Immediate Reconstruction ◽

Conservative Breast Surgery

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Oncoplastic Breast-Conserving Surgery: Analysis of Quadrantectomy and Immediate Reconstruction with Latissimus Dorsi Flap

World Journal of Surgery ◽

10.1007/s00268-007-9196-y ◽

2007 ◽

Vol 31 (10) ◽

pp. 1934-1940 ◽

Cited By ~ 31

Author(s):

Fernando Hernanz ◽

Sara Regaño ◽

Carlos Redondo-Figuero ◽

Victoria Orallo ◽

Fernando Erasun ◽

...

Keyword(s):

Latissimus Dorsi ◽

Breast Conserving Surgery ◽

Latissimus Dorsi Flap ◽

Immediate Reconstruction

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Superior Pedicle Quadrantectomy and Defect Reconstruction with an Inferior-Based Pedicle: Secondary Mastectomy and Immediate Reconstruction with a Latissimus Dorsi Flap

Oncoplastic Breast Surgery ◽

10.1007/978-3-7091-1874-0_24 ◽

2015 ◽

pp. 89-92

Author(s):

Peter Schrenk

Keyword(s):

Latissimus Dorsi ◽

Latissimus Dorsi Flap ◽

Immediate Reconstruction ◽

Superior Pedicle ◽

Defect Reconstruction

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Latissimus Dorsi Flap in Breast Reconstruction

Cancer Control ◽

10.1177/1073274817744638 ◽

2018 ◽

Vol 25 (1) ◽

pp. 107327481774463 ◽

Cited By ~ 16

Author(s):

Rachita Sood ◽

Jeena M. Easow ◽

Geoffrey Konopka ◽

Zubin J. Panthaki

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Perforator Flap ◽

Radical Mastectomy ◽

Latissimus Dorsi Flap ◽

Breast Cancer Surgery ◽

Soft Tissue Coverage ◽

Autologous Reconstruction ◽

Immediate Reconstruction ◽

Form And Function

Background: Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others. The LDF may be used in delayed or immediate reconstruction, in combination with tissue expanders for a staged reconstruction, with implant-based immediate reconstruction, or alone as an autogenous flap. Methods: The authors discuss the historical uses and more recent developments in the LDF. More recent advancements, including the “scarless” approach and augmentation with the thoracodorsal artery perforator flap, are discussed. Results: The LDF is a reliable means for soft tissue coverage providing form and function during breast reconstruction with acceptable perioperative and long-term morbidities. Conclusions: When there is a paucity of tissue, the LDF can provide tissue volume in autologous reconstruction, as well as a reliable vascular pedicle for implant-based reconstruction as in the setting of irradiated tissue.

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The outcome of Jarcho-Levin syndrome treated with a functional latissimus dorsi flap - A series of three cases

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.96582 ◽

2012 ◽

Vol 45 (01) ◽

pp. 040-044 ◽

Cited By ~ 1

Author(s):

Bipin A. Gangurde ◽

Binita Raut ◽

Rujuta Mehta ◽

Mukund R. Thatte

Keyword(s):

Chest Wall ◽

Latissimus Dorsi ◽

Respiratory Infections ◽

Lung Compliance ◽

Latissimus Dorsi Flap ◽

Life Saving ◽

Long Term Follow Up ◽

Term Basis

ABSTRACT Introduction: Jarcho-Levin syndrome is manifested by vertebral body and rib malformations. Large rib defects with paradoxical chest motion lead to early deathdue to progressive respiratory insufficiency, hence it is a lethal syndrome. The only means of improving survival is early stabilisation of the chest wall defect by containing the thoracic herniation. Nitcher et al. and Thatte et al. showed that reconstruction of the chest wall was life saving. Thatte et al. had postulated that early coverage of the lungs and thoracic contents with functional latissimus dorsi may prevent the visceral overgrowth and secondary pleural changes. Materials and Methods: Our three cases which had medium- and long-term follow-up help to support this postulation. Three patients were assessed retrospectively. Their ages at surgery were 6 months, 8 months and 1 year, respectively. All had laboured breathing and paradoxical respiration. All of them were operated with ipsilateral latissimus dorsi flap. Results: The results were evaluated clinically. The patients had reduced or no respiratory infections. The lung compliance improved and they had no tachypnoea on walking, running or playing. Conclusion: Hence, this can be used as a life-saving procedure for Jarcho-Levin syndrome on a long-term basis.

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