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Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions

Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracod...

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Autores principales: Choi, Jangyoun, Ko, Eun Jeong, Kim, Sung Ae, Choi, Jong Yun, Moon, Suk-Ho, Jun, Young Joon, Byeon, Jun Hee, Oh, Deuk Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9781814/
https://www.ncbi.nlm.nih.gov/pubmed/36556005
http://dx.doi.org/10.3390/jcm11247387
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author Choi, Jangyoun
Ko, Eun Jeong
Kim, Sung Ae
Choi, Jong Yun
Moon, Suk-Ho
Jun, Young Joon
Byeon, Jun Hee
Oh, Deuk Young
author_facet Choi, Jangyoun
Ko, Eun Jeong
Kim, Sung Ae
Choi, Jong Yun
Moon, Suk-Ho
Jun, Young Joon
Byeon, Jun Hee
Oh, Deuk Young
author_sort Choi, Jangyoun
collection PubMed
description Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the ‘anterior-first’ approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p < 0.001), and flap elevation (139 versus 200 min, p < 0.001). No difference in complication rate and time to drain removal was observed (p = 0.14 and >0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation.
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spelling pubmed-97818142022-12-24 Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions Choi, Jangyoun Ko, Eun Jeong Kim, Sung Ae Choi, Jong Yun Moon, Suk-Ho Jun, Young Joon Byeon, Jun Hee Oh, Deuk Young J Clin Med Article Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the ‘anterior-first’ approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p < 0.001), and flap elevation (139 versus 200 min, p < 0.001). No difference in complication rate and time to drain removal was observed (p = 0.14 and >0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation. MDPI 2022-12-13 /pmc/articles/PMC9781814/ /pubmed/36556005 http://dx.doi.org/10.3390/jcm11247387 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Choi, Jangyoun
Ko, Eun Jeong
Kim, Sung Ae
Choi, Jong Yun
Moon, Suk-Ho
Jun, Young Joon
Byeon, Jun Hee
Oh, Deuk Young
Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title_full Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title_fullStr Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title_full_unstemmed Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title_short Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions
title_sort anterior-first approach for latissimus dorsi myocutaneous flap breast reconstruction: a refined elevation method with detailed video instructions
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9781814/
https://www.ncbi.nlm.nih.gov/pubmed/36556005
http://dx.doi.org/10.3390/jcm11247387
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