Latissimus dorsi myocutaneous extended flap in the reconstruction of large chest wall defects after extensive resections in breast pathology

Abstract

Locally advanced breast cancer remains a major problem in developing countries and it is a common presentation of this condition worldwide. In Mexico, 45% of breast cancer cases are diagnosed at locally advanced stages. Cutaneous coverage of the chest wall after extensive resection in breast cancer patients has always been a challenge for the surgical team, and latissimus dorsi flap is therefore widely used for chest wall reconstruction. With the classic technique, the size of the skin flap is usually not larger than 10 cm. For this reason, the use of latissimus dorsi extended flap has been implemented in our institution with the purpose to cover large defects of up to 40 cm. A retrospective study was carried out of all latissimus dorsi extended flap cases over a five-year period. A total of 30 patients have undergone reconstruction with a latissimus dorsi flap, out of which 15 were treated with the extended technique, with tumor resections of up to 30 cm being achieved. Mean age was 42.6 years. Recorded tumor dimensions were as large as 30 cm. There was a low rate of complications requiring surgical re-intervention (6.6%) throughout an average 15.8-month follow-up. This technique is reproducible and is carried out in a single surgical procedure, and can be considered for partial or total reconstruction of large esthetical defects for purely palliative or curative purposes. The success of this technique depends on adequate patient selection and multidisciplinary treatment coordinated between breast and plastic surgeons.Copyright © 2017 Sociedad Mexicana de Oncologia.