Salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap
10.3760/cma.j.cn114453-20210219-00070
- VernacularTitle:胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用
- Author:
Dajiang SONG
1
;
Zan LI
;
Yixin ZHANG
;
Lei WANG
;
Aili SONG
Author Information
1. 湖南省肿瘤医院肿瘤整形外科，长沙 410008
- Keywords:
Surgical flaps;
Thoracodorsal artery;
Anterior serratus branch;
Pedicled skin flap;
Latissimus dorsi myocutaneous flap;
Breast reconstruction
- From:
Chinese Journal of Plastic Surgery
2022;38(6):612-618
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap.Methods:The anatomical study was conducted from September 2015 to December 2019. Four fresh adult female cadavers were dissected to measure the number, length, diameter and origin of the anterior serratus branch of the thoracodorsal artery. The clinical data of patients who underwent modified radical mastectomy and immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap from March 2015 to March 2019 were analyzed retrospectively. It was found that the thoracodorsal artery was damaged during the flap dissection and harvestion. The latissimus dorsi myocutaneous flap was harvested pedicled with the anterior serratus branch of the thoracodorsal artery as the pedicle to reconstruct the breast instead. Postoperative flap survival, breast appearance and texture, cancer recurrence and donor site were followed up.Results:A total of 11 branches of anterior serratus muscle were found in 4 specimens (8 sides), with a length of (6.3 ± 1.8) cm and a diameter of (2.4 ± 0.4) mm, including 7 from the trunk of dorsal thoracic artery, 3 from the vertical branch of dorsal thoracic artery and 1 from the horizontal branch of dorsal thoracic artery. A total of 6 female breast cancer patients aged 29-61 years, mean 42.7 years, were included in the clinical cases. The course of disease ranged from 2 to 36 months [(10.7 ± 5.4) months]. The area of secondary breast defect after modified mastectomy was 14 cm×6 cm to 16 cm×7 cm, the area of latissimus dorsi flap was 13 cm×6 cm to 17 cm×6 cm. All flaps survived thoroughly, the appearance of reconstructed breast was good. The follow-up ranged from 9 to 28 months, with an average of 13.7 months. The breast appearance and texture of all patients were satisfactory, there was no local recurrence, only linear scar was left in the donor area, and the shoulder joint activity was not affected.Conclusions:The anatomy of the anterior serratus branch of the thoracodorsal artery is constant, and the anatomical basis of communicating with the thoracodorsal artery can supply blood to the latissimus dorsi muscle. The pedicled latissimus dorsi myocutaneous flap with anterior serratus branch of thoracodorsal artery can effectively ensure the flap blood supply safety, and can be used as a salvage method for breast reconstruction in the case of thoracodorsal artery trunk injury.
