Application of internal thoracic artery perforator propeller flap combines with latissimus dorsi kiss flap to repair skin defects after breast wall tumor resection

Abstract

Objective To investigate the clinical value of internal thoracic artery perforator propeller flap combines with latissimus dorsi kiss flap in repairing large skin defect of chest wall after breast tumor operation. Methods A retrospective analysis was made on the clinical data from 6 cases of breast tumors admitted to the First Affiliated Hospital of Dalian Medical University between January 2018 and May 2019. There were 6 females with an average age of 55.5 years (range, 46-73 years); five of them were all locally advanced breast cancer, one of them was advanced breast cancer. The median disease duration is 20.1 months (range, 4 months to 5 years). Four of them accepted chemotherapy before surgery. The area of skin defect ranged from 10 cm× 15 cm to 21 cm× 31 cm after their primary tumor resection; the internal thoracic artery perforator propeller flap were designed to repair wounds primarily or combined with pedicled latissimus dorsi kiss flap. One of the patients had a large contralateral breast and underwent breast reduction and reconstruction simultaneously. Postoperative follow-up was conducted to observe the flap status and tumor recurrence. Results In the six cases, the size of internal thoracic artery perforator propeller flap was 5 cm× 12 cm to 10 cm× 23 cm. Three cases combined with kiss flap, with a size of 5 cm× 15 cm to 7 cm× 18 cm for each lobe. The flap of six patients survived successfully. Five flaps survived with primary healing of wound; one patient suffered from subcutaneous effusion due to a slightly larger tension in the donor area of the back, and delayed wound healing after dressing change and drainage. The follow-up time was from 1 to 17 months (mean, 7.5 months) after surgery. The flap had good appearance. The shoulder joint and lumbar activities were normal. No local recurrence occurred and no obvious scar were found at donor sites. Conclusions The application of internal thoracic artery perforator propeller flap and its combined flap in repairing chest wall huge skin defects after breast tumor resection has great clinical value, because no need of vessel anastomosis. It is simple, reliable and rapid postoperative recovery with few complication, and can achieve satisfactory result. Key words: Breast neoplasms; Perforator flap; Internal thoracic artery; Latissimus dorsi myocutaneous flap; Defect, skin soft tissue