Latissimus Dorsi Myocutaneous Research Articles

Three Cases of Traumatic Defect Reconstructions of the Foot Using Scapular Flap or Latissimus Dorsi Myocutaneous Flap

Three Cases of Traumatic Defect Reconstructions of the Foot Using Scapular Flap or Latissimus Dorsi Myocutaneous Flap

Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap

BackgroundPublished long-term outcomes of oncoplastic breast-conserving surgery are scarce and, specifically, aesthetic outcomes assessed with an objective method have not previously been published.MethodsA cohort of 41 patients treated with a quadrantectomny and immediate reconstruction using a myocutaneous latissimus dorsi flap were analyzed and their aesthetic outcomes were evaluated objectively by BCCT.core software.ResultsAt the end of a 58-month follow-up from the date of initial diagnosis, one patient (2.4%) developed an ipsilateral recurrence, six patients developed distant metastases and three patients died (7.3%) without ipsilateral recurrence, one of them presenting hepatic metastases at the time of the initial diagnosis. We were able to evaluate aesthetic results in 23 patients, 3 assessed as excellent, 12 good and 8 fair.ConclusionThis oncoplastic volume replacement technique obtained a good local control and satisfactory and stable aesthetic results which have maintained unchanged after a long period of time.

The Significance of Latissimus Dorsi Flap Innervation in Delayed Breast Reconstruction

It is controversial whether surgical denervation of the thoracodorsal nerve should be performed in breast reconstruction with a myocutaneous latissimus dorsi flap. Denervation may prevent discomforting symptoms caused by muscle contraction, but the flap may also lose significant volume. The authors prospectively evaluated the influence of latissimus dorsi flap innervation on the latissimus dorsi muscle structure in delayed breast reconstruction. Between 2007 and 2008, 28 breast reconstructions were performed and divided randomly into the denervation group (surgical denervation by excision of 1 cm of thoracodorsal nerve, n = 14) and the intact group (thoracodorsal nerve saved intact, n = 14). Muscle biopsy specimens were taken during the operation and 6 months after reconstruction. Histologic (hematoxylin and eosin), immunohistochemical (human developmental, neonatal, slow, and fast myosin heavy chains), and morphometric analyses were performed. Magnetic resonance imaging of the breasts was performed 1 and 12 months after surgery. There was a significant decrease in type I and type II myofiber diameters from 0 to 6 months in both groups. Denervation caused more significant atrophy than disuse alone. However, there was no significant difference in flap thickness between groups that can be explained by more pronounced fatty tissue infiltration in the denervation group. The authors' data suggest that the volume and consistency of the flap remain more or less the same, regardless of whether the thoracodorsal nerve is cut or not. Thus, in their practice, the authors do not cut the nerve to save surgical time. Therapeutic, II.

Thermoregulatory response of anterolateral thigh flap compared with latissimus dorsi myocutaneous flap: An evaluation of flaps cutaneous flow and velocity due to thermal stress

Although, the success of free flaps has increased in the last years, more details about its characteristics might improve the clinical outcome of the flaps. This study examined the thermoregulatory ability as a sign of neural re-innervation of two different types of microsurgical free flaps in the postoperative course. A total of 22 patients were examined after grafting two different flap types: The latissimus dorsi myocutaneous (LDM) flap (n = 11) and the anterolateral thigh (ALT) flap (n = 11). Patients were examined 6 and 9 months postoperatively. After exposure to cold and warm water (10°C and 35°C), multiple measurements were performed with the focus on blood velocity and flow using the "O2C" device. Both examined flaps showed a tendency for improvement in local blood flow and velocity due to thermal stress. We recorded a more physiological thermoregulation during thermal stress for the LDM flap, when compared with the ALT flap over a measured period of time. We believe that the presence of the muscle portion in the LDM flap may offer better conditions for thermoregulation based on the improvement of neural and vascular regeneration. However, further studies should clarify the pathophysiological backgrounds, to make these interesting results clinically applicable.

A new dimension: robotic reconstruction in plastic surgery.

Robot-assisted surgery was first approved by the Federal Drug Administration in 1994. The robotic system has the advantages of three-dimensional visualization of the operating field, 7° range of motion, tremor elimination, 360°of freedom at 10-mm distance, and a comfortable, seated operating posture. The purpose of this paper is to present a new surgical tool, the robot, for use in reconstructive surgery. A case is presented in which the robotic system was used to elevate a pedicled, myocutaneous latissimus dorsi flap for shoulder reconstruction. The robot was used successfully to harvest a pedicled latissimus dorsi flap. Since this case, we have used the robotic system to harvest one other pedicled latissimus flap for breast reconstruction as well as to perform the microvascular anastomoses in a radial forearm and rectus abdominus free flaps to the lower extremity. There is great potential for the use of robot as a surgical tool in the field of plastic surgery. The advantages are numerous, including superior visibility, greater range of motion as a more comfortable position for the operating surgeon. The limitations include the learning curve and the lack of biofeedback.

Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap

Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

Largest Phyllodes Tumor- Case Report and Brief Review Article

This is an article reporting the largest phyllodes tumor and the role of radiotherapy in patients of phyllodes tumor of breast, based on Medline search for articles in English language using keywords "role of radiotherapy in phyllodes tumor of breast". 32years female presented with a lump in right breast since last 4months. This was the second recurrence of similar lump in last 6years. Biopsy from the lump proved to be cystosarcoma phyllodes. Radical Mastectomy with level I node sampling and reconstruction with Latissimus Dorsi Myocutaneous flap was done as a curative procedure. The tumor measured exactly to be 50 × 25.2 × 16.4cm in size and 15kg in weight. Proliferation markers like Ki- 67 and p53 were in the range of 1-2% and 3-4% respectively. Histopathological diagnosis of the tumor was borderline phyllodes tumor. Patient had an uneventful postoperative course and is presently on three monthly follow up since 1year.

Treatment of the Severely Infected Frontal Sinus With Latissimus Dorsi Myocutaneous Free Flaps

In trauma patients with severe intracranial hemorrhaging, diagnosing facial bone fractures can be delayed. In frontal sinus fractures with nasofrontal duct obstruction, obliteration of the nasofrontal duct and the sinus is the current treatment of choice. But with inadequate management, ascending infections happen, and widely spread infections can involve the entire frontal soft tissues, which result in meningitis, encephalitis, and subcutaneous abscess pockets creating skin defects. In the treatment of these infections, radical debridement of all infected tissues including galea, pericranium, and surrounding soft tissues is obligatory; hence, available local vascularized flap options for obliteration of the postdebridement defect are scarce. In these situations, free-tissue transfer can be a treatment option. Although there have been numerous reports of using nonvascularized materials for obliteration of the frontal sinus, the material itself can serve as a nidus for infection, and it is generally accepted that well-vascularized tissues have greater ability to withstand local soft-tissue infection and osteomyelitis. Hence, we report 3 cases where we performed latissimus dorsi myocutaneous flaps for severe frontal sinus infections after frontal cranioplasty for severe hemorrhaging. Large bulks of muscle obliterated the nasofrontal duct and the dead space surrounding the entire frontal sinus. The latissimus dorsi myocutaneous flap is not a permanent solution for frontal sinus reconstruction, which requires a secondary bony reconstruction. However, when we face acute stages of intractable infections of the frontal sinus, it can control the infection and result in saving the patient's life.

Women's Quality of Life and Surgical Long-Term Outcome After Breast Reconstruction in Poland Syndrome Patients

In the last decades, several surgical approaches have been used to improve the appearance and quality of life of female Poland syndrome patients. The aim of this study was to analyze the women's quality of life and long-term outcome after breast reconstruction. Forty-nine women with Poland syndrome who were treated surgically between 1974 and 2007 received standardized questionnaires to evaluate their quality of life and satisfaction after surgical treatment. Patient response was 65%, with 32 completed questionnaires by 16 women who had pedicled latissimus dorsi myocutaneous (LDM) flaps, 12 with tissue expander or silicone implants, and 4 who had free transverse rectus abdominis myocutaneous (TRAM) flaps. Of these patients, 16 were satisfied or highly satisfied with their postoperative appearance (13 with LDM, 2 with prosthesis, and 1 with TRAM), 16 patients would recommend the same surgery to others under similar circumstances (10 with LDM, 5 with prosthesis, and 1 with TRAM), and 18 patients would choose the same method again (14 with LDM, 3 with prosthesis, and 1 with TRAM). In our study, we found that satisfactory outcome in breast reconstruction was achieved particularly when using the LDM flap, which remains the only method that recreates the anterior axillary fold. Future studies on reconstruction methods with autogenous tissue (e.g., TRAM, deep inferior epigastric perforator [DIEP] flap) are needed, however, to analyze quality of life and long-term outcome in patients with Poland syndrome.

Recovery of Sensation in Immediate Breast Reconstruction With Latissimus Dorsi Myocutaneous Flaps After Breast-Conservative Surgery and Skin-Sparing Mastectomy

In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

Scalp Reconstruction with Inverted Myocutaneous Latissimus Free Flap and Unmeshed Skin Graft

Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial artery isolation, titanium mesh is placed into the calvarial defect to recapitulate the inner table. The myocutaneous latissimus flap is harvested in standard fashion, deepithelialized, and inverted. The skin paddle is placed over titanium mesh to fill the calvarial defect, then sewn over a drain. The inverted latissimus muscle is draped over the defect and extended peripherally beneath the pericranium. The flap is sewn to the scalp internally using a vest-over-pants suture pattern, and the thoracodorsal and superficial temporal vessels are anastomosed and left facing outward. Unmeshed skin graft is draped over the muscle and vessels then sutured loosely. Patients with complex scalp defects whose soft tissue defect exceeded the size of latissimus skin paddle available with primary closure were considered eligible for inverted latissimus free flap reconstruction. Follow-up range was 6 months to 12 months. Over a 2-year period, five patients underwent inverted latissimus free flap reconstruction. Scalp defects ranged in size from 10 × 8 cm to 17 × 11 cm. The calvarial defect was smaller than the soft tissue defect in all cases. All flap donor sites were closed primarily. All five flaps took, and donor site outcomes were acceptable. Aesthetic outcomes were satisfactory with well-contoured, calvarial-shaped results. Cosmesis was most notably limited by skin graft joint lines. No patients underwent secondary surgical revision. The inverted myocutaneous latissimus free flap is a safe and effective method for reconstructing large or irradiated scalp defects.

A rare case of fungal osteomyelitis of the ribs requiring surgical reconstruction

I report a rare case of fungal osteomyelitis of ribs in a 23 year old male who presented with multiple discharging sinuses on the right side of the chest. The patient did not respond to medical management with fluconazole and ultimately surgical treatment in the form of excision of affected ribs and reconstruction with a pedicled myocutaneous latissimus dorsi flap had to be done. Fungal osteomyelitis although uncommon must always be thought of when treating a case of osteomyelitis of the ribs.

Dosimetric Coverage of Level I and II Lymph Nodes by Opposed Tangent Fields in Patients Undergoing PMRT with Tissue Expanders

To define the dosimetric coverage of level I and II lymph nodes regions in patients treated with tangent fields following mastectomy and tissue expander placement. Ten patients were identified who underwent mastectomy followed by immediate tissue expander placement followed by tangent field only radiation therapy planning. 9 patients had full axillary lymph node dissection. Eight patients also received bilateral mastectomy and bilateral expander placement. Regarding subsequent reconstruction of the treated breast, 8 patients had subpectoral implants and 2 had myocutaneous latissimus dorsi flaps. All patients underwent 3D planning with opposed tangential beams designed to encompass the chestwall with tissue expander. No patients received directed supraclavicular or other nodal irradiation. The axillary levels I and II were contoured retrospectively using the RTOG atlas and dose distributions to volumes of interest were determined using tabular dose volume histograms. All defined breast volumes received ≥ 95% of the prescribed dose. The mean axillary level I and II volume was 84.9 cm3 (range, 45.3 -138.6 cm3). No patient had complete coverage of the defined axillary volume by the 95% isodose line; the mean coverage of the axilla by the 95% isodose line was 32.4% (range, 3 - 65.4%). The mean volume of the axilla covered by the 95% isodose line was 28.3 cm3 (range, 1.49 - 90.6 cm3). In this study no patient received a therapeutic dose to levels I and II of the axilla. The volume of the axilla covered by the 95% isodose line is lower than published reports of patients treated following breast conserving surgery with tangents only. This may be due to anatomic definitions of the axilla; in particular, the superior extent may be greater in the RTOG atlas than definitions used in previous studies. On inspection of the dose distribution of the 95% isodose line, the superior aspect of Level II is never covered in contrast to the inferior border which has ample coverage. Difficulty exists in delineating the caudal extent of axillary level I based on the RTOG definition of insertion of the pectoralis muscle into the ribs, due to disruptions in normal pectoral anatomy caused by the tissue expander. As the evidence supporting post-mastectomy radiotherapy (PMRT) in those with 1-3 nodes increases, more patients with minimal axillary tumor burden are undergoing PMRT, This analysis suggests that in pts undergoing PMRT with tissue expanders in place, incidental doses delivered by opposed tangents to the Level I and II regions, as defined by the RTOG atlas, do not provide adequate dosimetric coverage of these regions. This should be considered when designing PMRT treatment fields.

Outcomes Evaluation Following Bilateral Breast Reconstruction Using Latissimus Dorsi Myocutaneous Flaps

The demand for bilateral breast reconstruction has recently increased. Although numerous options exist, the latissimus dorsi myocutaneous flap remains a popular technique. The benefits of additional autologous coverage are evident; however, donor site morbidity does exist. The purpose of this report is to evaluate our experience with bilateral latissimus dorsi breast reconstructions, focusing on donor site morbidity and patient satisfaction. All patients who underwent bilateral latissimus dorsi breast reconstruction at Emory University Hospital, were evaluated and included in the series. Data points queried included patient demographics, risk factors, radiation therapy, timing of the procedure (immediate or delayed), type of procedure (latissimus dorsi only, latissimus dorsi with expander, latissimus dorsi with implant), and outcomes. Outcomes included >1 additional operation, any breast and any donor-site complications. A patient satisfaction survey was performed evaluating outcomes such as aesthetic results, general satisfaction, morbidities, and functional assessment. Comparisons were made using radiation therapy, timing of reconstruction, and type of reconstruction as variables. Eighty-three patients underwent bilateral latissimus dorsi breast reconstruction with an average follow-up of 2.3 years. The method of reconstruction included latissimus dorsi with expander (n = 54), latissimus dorsi only (n = 17), and latissimus dorsi with implant (n = 12). Breast complications occurred in 34% of the patients with radiation therapy being a significant risk factor. The average number of secondary operations was 2.3 with the expander group resulting in an increased need for additional procedures. Overall patient satisfaction was 3.93/5, with the average symmetry score being 3.82/5, shape 3.84/5, nipple position 3.92/5, and inframammary fold (IMF) position 4/5. The majority of patients (n = 28/37) reported no pain (0/5) at the time of the survey. Most patients (n = 33/37) reported no impairment in daily activities, however, some did report impairment in physical activity, decreased range of motion (ROM), and pain. The latissimus dorsi remains a reliable option for bilateral breast reconstruction. Although patient satisfaction with this approach remains high, functional impairment can occur and needs to be appropriately discussed.

Oncological Safety and Quality of Life Associated with Mastectomy and Immediate Breast Reconstruction with a Latissimus Dorsi Myocutaneous Flap

To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, 1,699 had breast-conserving surgery (BCS) and 120 had a mastectomy with an immediate LD. We retrospectively compared the oncologic safety of the two techniques. We also assessed the QoL using the EORTC QLQ BR-23 and Zung's self-rating depression scale in 52 LD patients, 104 age- and stage-matched patients who underwent BCS, and 104 age-matched healthy women. The LD group had earlier stage disease than the BCS group at baseline, but following surgery, the groups did not differ in the rates of local recurrence or systemic metastases. Compared with the healthy group, the patient groups had poorer functioning and more depression (p < 0.001). Among the patient groups, the LD group reported lower scores for body image (p = 0.007) and future perspective (p = 0.023) than the BCS group. In the LD group, patients who received neoadjuvant chemotherapy reported lower scores for future perspective and higher scores for depression than those who did not receive neoadjuvant chemotherapy (p < 0.001). The BCS and LD groups did not differ in oncological outcome, and the QoL of patients in the LD group was not always good. Mastectomy with immediate reconstruction should be considered carefully and tailored to the patient's needs and characteristics.

A standardized grading scale for reconstructive process surgery in head and neck cancer.

e16000 Background: Following carcinologic operative step, head and neck cancer surgery requires a reconstructive step involving local or regional, pedicled or free flaps. Although the reconstructive technique specifics depend mainly on the surgical team, the functional goal is so important that the best choice should be fully understood and discussed by the multidisciplinary team, including all involved medical staff. At the present time, the too numerous reconstructive procedures explain the great difficulty in including surgical reconstructive treatments in head and neck cancer prospective international studies, particularly in functional and quality of life evaluation. Methods: We have retrospectively established this scale in head and neck reconstructive surgery, based on 197 pedicled flaps and 225 free flaps performed from 2004 to 2008. Results: Therefore, we are proposing the Poissonville 2009 grading scale (Table), gathering the various head and neck reconstructive procedures according to the surgical difficulty and duration. It can be easily applied to any head and neck anatomical area. Conclusions: This scale is aiming at including the reconstructive step within the existing therapeutic guidelines, allowing the inclusion of the patient's medical condition and functional requirements in the therapeutic choice. Moreover, the cost effectiveness of the surgery could be evaluated by this scale according to the surgical procedure as others cancer staging classifications. Standardized grading scale of flaps for head and neck reconstructive surgery (Poissonville 2009) S type Without flap Direct suture, healing, skin graft M type Local pedicled flaps FAMM, myocutaneous buccinator, nasolabial L type Regional head and neck pedicled flaps Platysma, infrahyoid myocutaneous, temporoparietal fascia XL type Beyond head and neck area pedicled flaps Myocutaneous pectoralis major, myocutaneous latissimus dorsi XXL type Free flaps with microvascular surgery NB(no bone) Fasciocutaneous or myocutaneous flaps Radial forearm, anterolateral thigh, lateral arm, scapular, latissimus dorsi B(bone) Osteocutaneous flaps Fibular, scapular, iliac crest D Digestive flaps Digestive Jejunal, gastro-omental No significant financial relationships to disclose.

An Algorithmic Approach to Breast Reconstruction Using Latissimus Dorsi Myocutaneous Flaps

Innovative surgical techniques developed by surgical oncologists have changed the landscape of mastectomy defects. Latissimus dorsi myocutaneous flap-based breast reconstruction provides a reliable foundation for breast reconstruction. The purpose of this study was to evaluate differential skin island designs with latissimus dorsi myocutaneous flap breast reconstruction, and to develop an algorithmic approach to breast reconstruction that is applicable to a broad spectrum of mastectomy defects. In this study, the authors retrospectively reviewed data of patients who underwent latissimus dorsi myocutaneous flap reconstruction following unilateral or bilateral mastectomies between February of 2001 and April of 2005. Patients were selected to undergo reconstruction under the following circumstances: (1) previously irradiated tissue, (2) body mass index greater than 30, (3) current tobacco use, (4) previous abdominopelvic surgery, and (5) patient preference. Patients were divided into three groups based on defect present: intact inframammary fold with skin deficit, intact inframammary fold without skin deficit, and absent inframammary fold with or without skin deficit. Differential skin island design was customized to the presenting mastectomy defect to optimize results and minimize donor-site scaring. Fifty-four patients underwent 64 latissimus dorsi myocutaneous flap reconstructions. Aesthetic outcomes and donor-site scar placement differed between groups. The authors have developed an algorithmic approach to latissimus dorsi myocutaneous flap breast reconstruction. Through critical evaluation of mastectomy defects, reconstructive breast surgeons can tailor skin island orientation, minimize donor-site scarring, enhance cosmetic outcomes, and provide a durable and natural aesthetic outcome in breast reconstruction with the latissimus dorsi myocutaneous flap.

Versatility of Chimeric Flap based on Thoracodorsal Vessels Incorporating Vascularized Scapular Bone and Latissimus Dorsi Myocutaneous Flap in Reconstructing Lower-extremity Bone Defects due to Osteomyelitis

To treat lower-extremity osteomyelitis secondary to trauma, bone and soft tissue can be grafted at the same time using microsurgical techniques. We investigate the use of chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap to reconstruct bone and soft-tissue defects of the lower leg due to osteomyelitis. Ten patients with lower-extremity bone and soft-tissue defects due to osteomyelitis were treated. Vascularized scapular bones were raised on the angular branch of the thoracodorsal artery. Latissimus dorsi myocutaneous flaps were elevated simultaneously to reconstruct the soft tissue defects. All patients tolerated the procedure well. One patient developed an early venous thrombosis, which was successfully treated by thrombectomy. Mean follow-up time was 7 years and 8 months. Bone union without refracture was observed in all patients. The mean time required for bone union after surgery was 13.5 weeks. Donor-site morbidity was minimal. Chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous are safe and effective in the repair of lower-extremity bone and soft-tissue defects caused by osteomyelitis.

Sentinel lymph node biopsy in breast cancer patients undergoing skin/nipple-sparing mastectomy and immediate autologous reconstruction

Immediate breast reconstruction following mastectomy is an effective treatment for breast cancer patients. Among several implant options, a latissimus dorsi myocutaneous (LDM) flap is used mainly due to the ease and minimal invasiveness of the procedure. The role of sentinel lymph node (SLN) biopsy with total mastectomy is evolving. Since SLN biopsy is not included in health insurance coverage in the treatment of patients in Japan, it is not generally performed as a separate procedure due to its cost. The present study reviewed the results of seven patients who underwent initial-staged SLN biopsy followed by planned mastectomy and LDM flap reconstruction. Two patients with positive SLNs showed macrometastases and underwent modified radical mastectomy with immediate reconstruction. In contrast, cases showing negative results for sentinel lymph nodes underwent total mastectomy. There were no false-negative cases among the SLN biopsy-negative cases. When an SLN is found to be positive on final pathology, the patient with reconstruction by LDM flap generally requires a potentially difficult reoperation on the remaining axillary nodes. When initial SLN biopsy is generally performed as a separate procedure in Japan, it will be an effective method for screening the axilla for patients who wish to undergo LDM flap reconstruction.

開頭術後頭蓋骨感染症に対する遊離肋骨移植と遊離広背筋皮弁移植を用いた頭蓋形成術の1例

人工骨による頭蓋形成術後に感染をきたしたため,感染骨除去を行った後に,遊離肋骨移植と遊離広背筋移植を用いた頭蓋形成術を施行した1例を報告する.症例は,49歳男性.破裂左中大脳動脈分岐部動脈瘤に対し,neck clippingに加え外減圧術を一期的に行った.1ヵ月後,hydroxyapatiteでの人工骨による頭蓋形成術を施行.14ヵ月後,人工骨感染と頭皮下から硬膜外にかけての膿瘍を認め,感染人工骨の除去とデブリードマンを行った.患部の炎症が消失した術2ヵ月後に,遊離肋骨移植と遊離広背筋皮弁移植による頭蓋形成術を行った.術後経過は良好で,2年が経過した現在も感染の徴候はない.