Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

Soft Tissue Defects of Neck and Shoulder Managed by Pedicled Latissimus Dorsi Myocutaneous Flap Transthoracic Transposition

BackgroundThe purpose of this study was to evaluate the effectiveness of latissimus dorsi myocutaneous flap in repairing neck and shoulder soft tissue defects combined with infection.MethodsA total of 11 patients with neck and shoulder soft tissue defects combined with infection, from July 2017 to December 2019, were treated by pedicled latissimus dorsi myocutaneous flap (PLDMF) in our department. There were 9 males and 2 females with an average age of 40.2±12.6 years. The mean defect size after debridement was (7.0±1.3) cm × (4.8±1.2) cm, and the average size of the flaps was (34.4±3.8) cm × (6.0±1.0) cm. The donor site was sutured directly. The postoperative blood supply in the transferred flap and function recovery of the affected limb were retrospectively collected and analyzed.ResultsSeven cases obtained direct healed without significant complications. Four cases developed postoperative infections at the distal ends of the skin flaps, and they were successfully treated by anti-infection treatment and repeated dressing changes. All patients were regularly followed up with an average of 17.3±3.8 months, satisfactory results with good flap blood supply and limb function were achieved in all patients, and no recurrence of infection was observed. ConclusionsPLDMF is a practically alternative treatment for the reconstruction of soft tissue defects combined with infection in neck and shoulder, including advantages of high survival rate, satisfactory functional recovery, and clinical practicality. However, surgical indications should be taken into account due to the inferior aesthetic appearance, especially for young female.

Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review

Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.

Pedicled Latissimus Dorsi Myocutaneous Flap Transthoracic Transposition for Repairing Neck and Shoulder Soft Tissue Defect Combined with Infection

Background: To explore the clinical application and selection of latissimus dorsi myocutaneous flap in repairing neck and shoulder soft tissue defect combined with infection. Methods: From July 2017 to December 2019, 11 patients with neck and shoulder soft tissue defect combined with infection in our hospital were repaired by the pedicled latissimus dorsi myocutaneous flap (PLDMF) according to the shape and size of the soft tissue defects, including 9 males and 2 females, with an average age of 40.2±12.6 years. The average defect area after debridement of infected and necrotic tissue was (7.0±1.3) cm × (4.8±1.2) cm, and the average area of the flaps was (34.4±3.8) cm × (6.0±1.0) cm. The donor site was sutured directly. Results: Seven cases of skin flaps healed by the first intention, while 4 cases developed infections at the distal ends of the skin flaps after surgery, which all survived after anti-infection treatment and repeated dressing changes for infection control, and the donor and recipient sites of the flaps healed well. Followed up for an average of 17.3±3.8 months with good flap blood supply and limb function, there was no recurrence of infection. Conclusions: PLDMF is an idea for repairing neck and shoulder soft tissue defect combined with infection, with high survival rate, low postoperative infection recurrence rate, and good functional repair ability, leading to good clinical application value. However, surgical indications should be strictly carried out due to the inferior aesthetic of flaps.