The Usefulness of Endoscopic Harvesting of the Latissimus Dorsi Flap for Breast Reconstruction Using a Single-Port and CO
Breast reconstruction
CO2 insufflation technique
Endoscopic harvesting
Latissimus dorsi flap
Oncoplastic surgery
Single-port technique
Journal
Aesthetic plastic surgery
ISSN: 1432-5241
Titre abrégé: Aesthetic Plast Surg
Pays: United States
ID NLM: 7701756
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
07
06
2021
accepted:
05
07
2021
pubmed:
1
8
2021
medline:
8
1
2022
entrez:
31
7
2021
Statut:
ppublish
Résumé
In the recent trend toward less aggressive approaches to breast reconstruction, minimally invasive harvesting of the latissimus dorsi (LD) flaps has long been a desirable goal. Endoscopically-assisted LD flap harvesting was reported as a method for minimizing scar formation and reducing donor-site morbidity. This study investigates the surgical outcomes of endoscopically-assisted immediate breast reconstruction with LD muscle flaps. This prospective study included 21 patients who underwent endoscopically-assisted breast reconstruction with LD muscle flap and 20 patients who underwent breast reconstruction with conventional harvesting LD musculocutaneous flap. In patients with nonexcised skin or possible primary closure, the reconstruction was performed with endoscopically-assisted LD muscle flaps using the single-port and CO In patients who underwent endoscopically-assisted breast reconstruction with LD muscle flaps, the scar of the donor-site was vertical, and the size was 4 cm to be obscured when lowering the arms. In comparison with patients who underwent breast reconstruction with conventional LD flaps, those who underwent endoscopically-assisted breast reconstruction with LD muscle flaps showed shorter hospital stay and no difference in patient satisfaction. Endoscopically-assisted breast reconstruction with LD flaps showed no difference in patient satisfaction with good esthetic results compared with conventional LD flaps. The endoscopic LD muscle flap harvest technique using a single-port and CO2 insufflation technique can be very useful in breast reconstruction that does not require a skin paddle. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Sections du résumé
BACKGROUND
In the recent trend toward less aggressive approaches to breast reconstruction, minimally invasive harvesting of the latissimus dorsi (LD) flaps has long been a desirable goal. Endoscopically-assisted LD flap harvesting was reported as a method for minimizing scar formation and reducing donor-site morbidity. This study investigates the surgical outcomes of endoscopically-assisted immediate breast reconstruction with LD muscle flaps.
MATERIALS AND METHODS
This prospective study included 21 patients who underwent endoscopically-assisted breast reconstruction with LD muscle flap and 20 patients who underwent breast reconstruction with conventional harvesting LD musculocutaneous flap. In patients with nonexcised skin or possible primary closure, the reconstruction was performed with endoscopically-assisted LD muscle flaps using the single-port and CO
RESULTS
In patients who underwent endoscopically-assisted breast reconstruction with LD muscle flaps, the scar of the donor-site was vertical, and the size was 4 cm to be obscured when lowering the arms. In comparison with patients who underwent breast reconstruction with conventional LD flaps, those who underwent endoscopically-assisted breast reconstruction with LD muscle flaps showed shorter hospital stay and no difference in patient satisfaction.
CONCLUSION
Endoscopically-assisted breast reconstruction with LD flaps showed no difference in patient satisfaction with good esthetic results compared with conventional LD flaps. The endoscopic LD muscle flap harvest technique using a single-port and CO2 insufflation technique can be very useful in breast reconstruction that does not require a skin paddle.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Identifiants
pubmed: 34331099
doi: 10.1007/s00266-021-02467-1
pii: 10.1007/s00266-021-02467-1
doi:
Substances chimiques
Carbon Dioxide
142M471B3J
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2681-2690Informations de copyright
© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.
Références
Park HC, Kim HY, Kim MC et al (2014) Partial breast reconstruction using various oncoplastic techniques for centrally located breast cancer. Arch Plast Surg 41:520–528
doi: 10.5999/aps.2014.41.5.520
Yang JD, Kim MC, Lee JW et al (2012) Usefulness of oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts. Arch Plast Surg 39:489–496
doi: 10.5999/aps.2012.39.5.489
Fine NA, Orgill DP, Pribaz JJ (1994) Early clinical experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg 33:465
doi: 10.1097/00000637-199411000-00001
Cho BC, Lee JH, Ramasastry SS, Baik BS (1997) Free latissimus dorsi muscle transfer using an endoscopic technique. Ann Plast Surg 38:586
doi: 10.1097/00000637-199706000-00004
Lin CH, Wei FC, Levin LS, Chen MC (1999) Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 104:1070–1077
doi: 10.1097/00006534-199909020-00030
Cha W, Jeong WJ, Anh SH (2013) Latissimus dorsi muscle free flap revisited: a novel endoscope-assisted approach. Laryngoscope 123:613–617
doi: 10.1002/lary.23757
Pomel C, Missana MC, Lasser P (2002) Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery: feasibility study and review of the literature. Ann Chir 127:337–342
doi: 10.1016/S0003-3944(02)00769-1
Marie C, Pomel C (2007) Endoscopic latissimus dorsi flap harvesting. Am J Surg 194:164–169
doi: 10.1016/j.amjsurg.2006.10.029
Kiiski J, Kaartinen I, Kotaluoto S, Kuokkanen H (2017) Modified approach for endoscopic harvest of the latissimus dorsi free flap with CO
doi: 10.1002/micr.30127
Miller MJ, Robb GL (1995) Endoscopic technique for free flap harvesting: review. Clin Plast Surg 22:755–773
doi: 10.1016/S0094-1298(20)31174-3
Ramakrishnan VV, Southern S, Villafane O (1997) Endoscopic harvest of the latissimus dorsi muscle using the balloon dissection technique. Plast Reconstr Surg 99:899–903 (discussion 904-905)
doi: 10.1097/00006534-199703000-00049
Selber JC (2011) Robotic latissimus dorsi muscle harvest. Plast Reconstr Surg 128:88e–90e
doi: 10.1097/PRS.0b013e31821ef25d
Lee J, Jung JH, Kim WW et al (2020) Endoscopy-assisted muscle-sparing Latissimus Dorsi muscle flap harvesting for partial breast reconstruction. BMC Surg 20:192
doi: 10.1186/s12893-020-00853-1
Yuh BE, Hussain A, Chandrasekhar R et al (2010) Comparative analysis of global practice in urologic robot-assisted surgery. J Endourol 24:1637–1644
doi: 10.1089/end.2010.0024
Leff DR, Vashisht R, Yongue G et al (2011) Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery? Breast Cancer Res Treat 125:607–625
doi: 10.1007/s10549-010-1258-4
Sakamoto N, Fukuma E, Higa K et al (2009) Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol 16:3406–3413
doi: 10.1245/s10434-009-0661-8
Missana MC, Pomel C (2007) Endoscopic latissimus dorsi flap harvesting. Am J Surg 194:164–169
doi: 10.1016/j.amjsurg.2006.10.029
Pomel C, Missana MC, Atallah D, Lasser P (2003) Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol 29:127–131
doi: 10.1053/ejso.2002.1326
Toesca A, Peradze N, Manconi A et al (2017) Robotic nipple-sparing mastectomy for the treatment of breast cancer: feasibility and safety study. Breast 31:51–56
doi: 10.1016/j.breast.2016.10.009
Toesca A, Peradze N, Manconi A et al (2017) Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg 266:e28-30
doi: 10.1097/SLA.0000000000001397
Selber JC, Baumann DP, Holsinger FC (2012) Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg 129:1305–1312
doi: 10.1097/PRS.0b013e31824ecc0b
Chang HP, Fan KL, Song SY, Lee DW (2020) The traditional versus endoscopic-assisted latissimus dorsi harvest in oncoplastic surgery: a long term comparison of breast volume, aesthetics, and donor site outcomes. Asian J Surg 43:1165–1171
doi: 10.1016/j.asjsur.2020.03.002
Schmidt M, Moritz T, Shamiyeh A et al (2019) Posterior intercostal artery perforator flap for posterior trunk reconstruction: perforator mapping with high-resolusion ultrasound and clinical application. J Plast Reconstr Aesthet Surg 72:737–743
doi: 10.1016/j.bjps.2018.12.005
Brunetti B, Tenna S, Aveta A et al (2016) Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: clinical experience on 20 consecutive oncological cases. Microsurgery 36:546–551
doi: 10.1002/micr.22408