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Abstract
Given the absence of a specific published study on the use of a pedicled and tunneled partial latissimus dorsi flap for the coverage of post-radiotherapy ulcerative Grade 4 breast radiodermatitis, this study aims to address this gap by reporting our experience through a description of the technique used and illustrating a clinical case. We present the tunneled muscle-sparing latissimus dorsi harvesting technique, including the various operative steps: - Lesion excision - Flap marking - Flap dissection - Tunnel creation - Flap transposition and fixation - Drainage and closure. We illustrate this technique with a clinical case of a 68-year-old patient with a history of lumpectomy (18 years prior) and radiotherapy (17 years prior) for Grade 4 ulcerative left breast radiodermatitis post-radiotherapy, who was treated with a tunneled partial latissimus dorsi flap. Two years after reconstructive surgery, the results are excellent, with complete patient satisfaction. This technique has many advantages: No microanastomosis; Preservation of latissimus dorsi function; Well-vascularized flap, resistant to infection and residual radiation; Ability to cover large volumes; Short operating time and low morbidity.
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References
- 1. Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg. 1 avr 2003;111(4):1407‑11.
- 2. Oberhofer HM, Samant SS, Swan CC, Wolfe EM, Satteson ES, Leyngold MM, et al. Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps. Plast Reconstr Surg. mai 2022;149(5):966e‑71e.
- 3. Wong C, Saint-Cyr M. The pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction. J Plast Reconstr Aesthet Surg. avr 2010;63(4):623‑32.
- 4. Ismaïl M, Boucher F, Chauvel-Picard J, Shipkov H, Braye F, Mojallal A. Séquelles du prélèvement du lambeau de grand dorsal et ses dérivés – Revue de la littérature. Ann Chir Plast Esthét. oct 2014;59(5):348‑54.
- 5. Tan O, Algan S, Denktas Kuduban S, Cinal H, Zafer Barin E, Ulvi H. Versatile use of the muscle and nerve sparing latissimus dorsi flap. Microsurgery. févr 2012;32(2):103‑10.
- 6. Hopewell JW. The volume effect in radiotherapy–its biological significance. Br J Radiol 1997; 70 (Spec No):S32–40.
- 7. Maciejewski B, Withers HR, Taylor JM, Hliniak A. Dose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx. Part 2. Normal tissue responses: acute and late effects. Int J Radiat Oncol Biol Phys 1990;18:101–11.
- 8. Pinnix C, Perkins GH, Strom EA, Tereffe W, Woodward W, Oh JL, et al. Topical hyaluronic acid vs. standard of care for the prevention of radiation dermatitis after adjuvant radiotherapy for breast cancer: single-blind randomized Phase III clinical trial. Int J Radiat Oncol Biol Phys 2012;83:1089–94.
- 9. Hopewell JW. The skin: its structure and response to ionizing radiation. Int J Radiat Biol
- 10. Lee KT, Mun GH. A Systematic Review of Functional Donor-Site Morbidity after Latissimus Dorsi Muscle Transfer: Plast Reconstr Surg. août 2014;134(2):303‑14.
- 11. Spear SL, Hess CL. A Review of the Biomechanical and Functional Changes in the Shoulder following Transfer of the Latissimus Dorsi Muscles: Plast Reconstr Surg. juin 2005;115(7):2070‑3.
- 12. Giordano S, Kääriäinen M, Alavaikko J, Kaistila T, Kuokkanen H. Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run. Scand J Surg. sept 2011;100(3):202‑7.
- 13. Fauconnier MB, Burnier P, Jankowski C, Loustalot C, Coutant C, Vincent L. Comparison of postoperative complications following conventional latissimus dorsi flap versus muscle-sparing latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg. oct 2022;75(10):3653‑63.
- 14. Kim H, Wiraatmadja ES, Lim SY, Pyon JK, Bang SI, Oh KS, et al. Comparison of morbidity of donor site following pedicled muscle-sparing latissimus dorsi flap versus extended latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg. mai 2013;66(5):640‑6.
- 15. Oberhofer HM, Samant SS, Swan CC, Wolfe EM, Satteson ES, Leyngold MM, et al. Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps. Plast Reconstr Surg. mai 2022;149(5):966e‑71e.
- 16. Piccart-Gebhart MJ, Procter M, Leyland-Jones B et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. New England Journal of Medicine 2005;353:1659-72.
- 17. Pinto AC, Ades F, De Azambuja E, Piccart- Gebhart M. Trastuzumab for patients with HER2 positive breast cancer: delivery, duration and combination therapies. Breast 2013; 22 (suppl 2): S152-S155.
- 18. The incidence of postoperative radiotherapy-induced acute dermatitis in breast cancer and its influencing factors for Chinese women.Ding J#1,2, Guo Y#3, Li Q1,Chen J4, Hu P4, Liu Q4, Cao Y4, Wu J5,6. 25. Rev Enferm. 2013 Dec;36(12):42-8.[Radiation therapy in breast cancer. Education and care nurses].[Article in Spanish]Castaños Jaúregui I1, Balsa Marco JC1.
- 19. Topical Treatment of Skin Injury Inflicted in Mice by X-Ray Irradiation.Meimeti E1, Kafanas A2, Pavlou P1, Evangelatou A3, Tsouparelou P3, Kanellopoulos S3, Kipouros P3, Koliarakis N3, Leonis G1, Ioannou E4, Roussis V4, Rallis M1
References
1. Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg. 1 avr 2003;111(4):1407‑11.
2. Oberhofer HM, Samant SS, Swan CC, Wolfe EM, Satteson ES, Leyngold MM, et al. Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps. Plast Reconstr Surg. mai 2022;149(5):966e‑71e.
3. Wong C, Saint-Cyr M. The pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction. J Plast Reconstr Aesthet Surg. avr 2010;63(4):623‑32.
4. Ismaïl M, Boucher F, Chauvel-Picard J, Shipkov H, Braye F, Mojallal A. Séquelles du prélèvement du lambeau de grand dorsal et ses dérivés – Revue de la littérature. Ann Chir Plast Esthét. oct 2014;59(5):348‑54.
5. Tan O, Algan S, Denktas Kuduban S, Cinal H, Zafer Barin E, Ulvi H. Versatile use of the muscle and nerve sparing latissimus dorsi flap. Microsurgery. févr 2012;32(2):103‑10.
6. Hopewell JW. The volume effect in radiotherapy–its biological significance. Br J Radiol 1997; 70 (Spec No):S32–40.
7. Maciejewski B, Withers HR, Taylor JM, Hliniak A. Dose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx. Part 2. Normal tissue responses: acute and late effects. Int J Radiat Oncol Biol Phys 1990;18:101–11.
8. Pinnix C, Perkins GH, Strom EA, Tereffe W, Woodward W, Oh JL, et al. Topical hyaluronic acid vs. standard of care for the prevention of radiation dermatitis after adjuvant radiotherapy for breast cancer: single-blind randomized Phase III clinical trial. Int J Radiat Oncol Biol Phys 2012;83:1089–94.
9. Hopewell JW. The skin: its structure and response to ionizing radiation. Int J Radiat Biol
10. Lee KT, Mun GH. A Systematic Review of Functional Donor-Site Morbidity after Latissimus Dorsi Muscle Transfer: Plast Reconstr Surg. août 2014;134(2):303‑14.
11. Spear SL, Hess CL. A Review of the Biomechanical and Functional Changes in the Shoulder following Transfer of the Latissimus Dorsi Muscles: Plast Reconstr Surg. juin 2005;115(7):2070‑3.
12. Giordano S, Kääriäinen M, Alavaikko J, Kaistila T, Kuokkanen H. Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run. Scand J Surg. sept 2011;100(3):202‑7.
13. Fauconnier MB, Burnier P, Jankowski C, Loustalot C, Coutant C, Vincent L. Comparison of postoperative complications following conventional latissimus dorsi flap versus muscle-sparing latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg. oct 2022;75(10):3653‑63.
14. Kim H, Wiraatmadja ES, Lim SY, Pyon JK, Bang SI, Oh KS, et al. Comparison of morbidity of donor site following pedicled muscle-sparing latissimus dorsi flap versus extended latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg. mai 2013;66(5):640‑6.
15. Oberhofer HM, Samant SS, Swan CC, Wolfe EM, Satteson ES, Leyngold MM, et al. Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps. Plast Reconstr Surg. mai 2022;149(5):966e‑71e.
16. Piccart-Gebhart MJ, Procter M, Leyland-Jones B et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. New England Journal of Medicine 2005;353:1659-72.
17. Pinto AC, Ades F, De Azambuja E, Piccart- Gebhart M. Trastuzumab for patients with HER2 positive breast cancer: delivery, duration and combination therapies. Breast 2013; 22 (suppl 2): S152-S155.
18. The incidence of postoperative radiotherapy-induced acute dermatitis in breast cancer and its influencing factors for Chinese women.Ding J#1,2, Guo Y#3, Li Q1,Chen J4, Hu P4, Liu Q4, Cao Y4, Wu J5,6. 25. Rev Enferm. 2013 Dec;36(12):42-8.[Radiation therapy in breast cancer. Education and care nurses].[Article in Spanish]Castaños Jaúregui I1, Balsa Marco JC1.
19. Topical Treatment of Skin Injury Inflicted in Mice by X-Ray Irradiation.Meimeti E1, Kafanas A2, Pavlou P1, Evangelatou A3, Tsouparelou P3, Kanellopoulos S3, Kipouros P3, Koliarakis N3, Leonis G1, Ioannou E4, Roussis V4, Rallis M1