“Wing-Shaped Skin Component of Latissimus Dorsi Myocutaneous Flap Design for Breast Reconstruction—Useful Innovation”

Abstract

We describe a pedicled latissimus dorsi myocutaneous (LDMC) flap with a wing-shaped skin paddle to cover large breast defects. It allows primary closure of the donor site with the added advantage of some flap projection. This is performed utilising the principles of M-plasty and the anatomy of thoracodorsal musculocutaneous perforators, which would not be possible with the conventional flap design. Analysis of a series of 23 patients who underwent breast reconstruction using wing shaped skin component LDMC technique between 2011 and 2019 in a breast unit of a Tertiary Care Hospital is presented here. Patient characteristics, technical details, and outcomes were analysed. Mean patient age was 41 (SD 10.9) years. The mean defect dimensions were 13.5 (SD 3.4) cm and 10.5 (SD 2.6) cm in length and width, respectively. The mean flap area was 147 (SD 67.2 cm2).The donor site defect was closed primarily in all the cases. The average length of inhospital stay was 4.9 (SD 1.5) days (range 3–9 days). One patient (4.3%) had marginal necrosis of the flap, three patients (13%) had donor site seroma, and two patients (8.7%) suffered donor site wound dehiscence. None of the complications entailed re-surgery or delay the onset of adjuvant therapy. At a mean follow-up of 37.5 (SD 33.9) months, none of the patients reported tumour recurrence or donor site morbidity. Wing-shaped skin component of latissimus dorsi myocutaneous flap offers a simple and reliable pedicled flap to cover large breast defects with minimal donor site morbidity. It creates a mild breast mound and may avoid the use of implants and its associated complications in small-breasted patients. It can be conveniently performed in non-microsurgical setups.