Background: The authors report their experience using extended transversely
oriented skin paddles in muscle-sparing latissimus dorsi pedicled flaps for
breast reconstruction as an alternative to thoracodorsal artery perforator
flaps.
Methods: A retrospective review was conducted of patients who underwent
muscle-sparing latissimus dorsi flap pedicled breast reconstruction from
January of 2009 to July of 2014 with at least 3-month follow-up. Surgical
outcomes and complications were analyzed.
Results: Fifty-three patients underwent a total of 81 muscle-sparing latissimus
dorsi pedicled flaps for breast reconstruction. Extended transversely oriented
skin paddles ranged from 7 to 9 cm vertically by 25 to 35 cm horizontally and
were perfused by a strip of latissimus dorsi muscle that was approximately 25
percent of the total muscular volume. Twenty patients had indocyanine green
angiography revealing three distinct zones of perfusion in the extended
transversely oriented skin paddles. The area of earliest perfusion (designated
zone 1) was directly over the muscle containing the perforators. The second
best area of perfusion (zone 2) was lateral to the muscle (toward the axilla).
The last and relatively least well-perfused area (zone 3) was medial to the
muscle (toward the spine). Zone 3 still had adequate viability. There were no
flap losses. Minor complications included wound infection [six of 81 (7.4
percent)], fat necrosis [three of 81 (3.7 percent)], and seroma [four of 81
(4.9 percent)].
Conclusions: Muscle-sparing latissimus dorsi pedicled
flaps with extended transversely oriented skin paddles are reliable
alternatives to thoracodorsal artery perforator flaps for breast
reconstruction. Three zones of perfusion were delineated in the extended
transversely oriented skin paddles on indocyanine green imaging, and all three
zones were viable. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
