Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction
Background:. A transverse paddle latissimus dorsi (LD) flap has the advantage that if the skin paddle is placed in the transverse bra line, the donor site scar is well hidden by underwear. With this transfer, medial back tissues are usually moved to the medial area of the reconstructed breast follow...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2021-07-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003695 |
| _version_ | 1823929094018957312 |
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| author | Toshiaki Numajiri, MD, PhD Daiki Morita, MD Shoko Tsujiko, MD Yoshio Moriguchi, MD, PhD |
| author_facet | Toshiaki Numajiri, MD, PhD Daiki Morita, MD Shoko Tsujiko, MD Yoshio Moriguchi, MD, PhD |
| author_sort | Toshiaki Numajiri, MD, PhD |
| collection | DOAJ |
| description | Background:. A transverse paddle latissimus dorsi (LD) flap has the advantage that if the skin paddle is placed in the transverse bra line, the donor site scar is well hidden by underwear. With this transfer, medial back tissues are usually moved to the medial area of the reconstructed breast following 180 degree rotation. Because these tissues are thinner than the lateral thoracic area, the medial part of the reconstructed breast sometimes becomes flatter than expected.
Methods:. To add bulk in the medial lower quadrant for giving an impression of an outward-expanding breast, we modified the LD flap by adding a part of the trapezius muscle. Seven patients underwent mastectomy and simultaneously received a modified LD flap. To hide the donor site scar beneath underwear, the skin paddle needed to be oriented transversely. The additional harvested tissues were tested for vascularity by fluorescence following intravascular injections of indocyanine green. If this was negative, the tissue was not used for breast reconstruction. Postoperatively, another surgeon judged whether this modification had contributed favorably to the reconstructed medial lower quadrant.
Results:. Indocyanine green testing was positive in six cases. The shape of the lower medial quadrant was judged as good in five of the seven cases. Complications included an animation deformity of the LD muscle, donor site seroma, and donor site wound dehiscence.
Conclusion:. This transversely oriented LD flap with extension to the trapezius muscle placed at the bra-line is one option to add bulk to the medial lower quadrant of the reconstructed breast when an additional scar is not desired for cosmetic reasons. |
| first_indexed | 2024-12-16T21:04:02Z |
| format | Article |
| id | doaj.art-fdbbd8ca79c94f4daeec200154505307 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-16T21:04:02Z |
| publishDate | 2021-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-fdbbd8ca79c94f4daeec2001545053072022-12-21T22:16:21ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-07-0197e369510.1097/GOX.0000000000003695202107000-00041Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast ReconstructionToshiaki Numajiri, MD, PhD0Daiki Morita, MD1Shoko Tsujiko, MD2Yoshio Moriguchi, MD, PhD3From the * Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, JapanFrom the * Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, JapanFrom the * Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan† Department of Breast Surgery, Kyoto City Hospital, Kyoto, Japan.Background:. A transverse paddle latissimus dorsi (LD) flap has the advantage that if the skin paddle is placed in the transverse bra line, the donor site scar is well hidden by underwear. With this transfer, medial back tissues are usually moved to the medial area of the reconstructed breast following 180 degree rotation. Because these tissues are thinner than the lateral thoracic area, the medial part of the reconstructed breast sometimes becomes flatter than expected. Methods:. To add bulk in the medial lower quadrant for giving an impression of an outward-expanding breast, we modified the LD flap by adding a part of the trapezius muscle. Seven patients underwent mastectomy and simultaneously received a modified LD flap. To hide the donor site scar beneath underwear, the skin paddle needed to be oriented transversely. The additional harvested tissues were tested for vascularity by fluorescence following intravascular injections of indocyanine green. If this was negative, the tissue was not used for breast reconstruction. Postoperatively, another surgeon judged whether this modification had contributed favorably to the reconstructed medial lower quadrant. Results:. Indocyanine green testing was positive in six cases. The shape of the lower medial quadrant was judged as good in five of the seven cases. Complications included an animation deformity of the LD muscle, donor site seroma, and donor site wound dehiscence. Conclusion:. This transversely oriented LD flap with extension to the trapezius muscle placed at the bra-line is one option to add bulk to the medial lower quadrant of the reconstructed breast when an additional scar is not desired for cosmetic reasons.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003695 |
| spellingShingle | Toshiaki Numajiri, MD, PhD Daiki Morita, MD Shoko Tsujiko, MD Yoshio Moriguchi, MD, PhD Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction |
| title_full | Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction |
| title_fullStr | Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction |
| title_full_unstemmed | Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction |
| title_short | Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction |
| title_sort | extension toward the trapezius in a transversely oriented latissimus dorsi flap for breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003695 |
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