Revisiting the latissimus dorsi flap: A potential first-line option breast reconstruction
Jordan P. Bloom, B.S., Peter R. Bucciarelli, B.S., Brent R. DeGeorge, Jr., M.D.,Ph.D., Steven E. Copit, M.D..
Thomas Jefferson University, Philadelphia, PA, USA.
BACKGROUND: The latissimus dorsi musculocutaneous flap has been previously established as a safe, effective, and aesthetically pleasing option for immediate and delayed breast reconstruction; however at present latissimus dorsi flap-based breast reconstruction (LDFBR) accounts for only 9% of total breast reconstruction operative cases with the majority of reconstructions utilizing other techniques [1-3]. LDFBR and free tissue transfer have demonstrated equivalent patient-centered outcomes including post-operative aesthetic appearance and patient satisfaction, however LDBFR is associated with a reduced incidence of overall complications including total flap loss, fat necrosis, contour deformity, and donor site morbidity compared to that of free tissue transfer-based techniques. Furthermore, LDBFR is associated with decreased operative times, decreased length of post-operative stay, decreased cost, and can be performed by a single surgeon. Taken together, LDFBR is a grossly underutilized technique for breast reconstruction. In the present work, we aim to establish that given the appropriate patient selection criteria, LDFBR should be viewed as a first-line option for both primary and delayed reconstruction of the breast.
METHODS:A retrospective review of patient data collected between May 2002 and September 2009 encompassing over 450 LDFBRs at Thomas Jefferson University Hospital by a single surgeon. Data on preoperative parameters, operative details, and postoperative course including the following endpoints: flap complications, donor site morbidity, length of stay, and aesthetic appearance were collected. Complications were graded according to previously published scales. Analyses were performed using univariate and multivariable models.
RESULTS:Patients who underwent LDFBR had a low incidence of complications. This finding was consistent irrespective of previous radiation exposure, prior surgical procedures, smoking status and body mass index.
CONCLUSIONS:LDFBR is a safe and reasonable first-line choice for breast reconstruction with a low incidence of flap complications, donor site morbidity, and hospital costs. Based on our experience, LDFBR can be considered when other reconstructive options are contraindicated due to patient parameters including smoking, prior radiation exposure, and in cases of re-operation for failed prior breast reconstruction. Furthermore, LDFBR can be performed by a single surgeon in either the inpatient or outpatient setting with minimal post-operative monitoring.
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