Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions.

Choi, Jangyoun; Ko, Eun Jeong; Kim, Sung Ae; Choi, Jong Yun; Moon, Suk-Ho; Jun, Young Joon; Byeon, Jun Hee; Oh, Deuk Young

Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the 'anterior-first' approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p 0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation.

MAMMAPLASTY; MUSCULOCUTANEOUS flaps; ARTERIAL catheterization; VASCULAR smooth muscle; LATISSIMUS dorsi (Muscles); SURFACE reconstruction; MASTECTOMY

Journal of Clinical Medicine, 2022, Vol 11, Issue 24, p7387

2077-0383

Academic Journal

10.3390/jcm11247387