Outcome of Latissimus Dorsi Flap Chest Wall Reconstruction In Rajavithi Hospital
Santi Lokejareonlarb MD, FRCS*, Panyawat Chamalerk MD*
Affiliation : * Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Latissimus Dorsi flap (LD flap) has been used since the eighteenth century to cover large chest wall defects after
total mastectomy and is thought to be superior to split thickness skin graft in terms of both cosmetic results and functionality.
The outcomes and complications resulting from the use of LD flap reconstruction for large breast cancer are not well
documented in Thailand.
Objective : To describe a technique using the Latissimus Dorsi musculocutaneous flap for breast reconstruction. The outcomes,
complications and length of stay after operation were also reported.
Material and Method: Between 2009 and 2014, fifty-five patients with large breast cancer with skin involvement were
selected. Of these, forty-four cases had modified radical mastectomy (MRM) alone, and eleven cases underwent total
mastectomy with immediate LD flap chest wall reconstruction. The age of the patients ranged from 33 to 81 years. The flap-
related complications and donor site morbidity were evaluated. This retrospective study was reviewed and approved by the
ethics committee, Rajavithi Hospital.
Results : The eleven patients with LD flap for breast reconstruction had a mean age of 53.82+14.50 years (range 33 to 81).
All tumors were T4 lesions, and the mean tumor size was 15 cm. Average body mass index (BMI) was 23.83+4.18 kg/m2,
hematocrit (Hct) was 34.90+4.06% and albumin (Alb) was 3.68+1.03 mg/dl. Three patients had diabetes mellitus and two
had hypertension. Six of these LD flap patients had the following postoperative complications: wound infections (36.36%);
wound dehiscence (27.27%); seroma (18.18%); and partial flap loss (27.27%). No patient had total flap loss. Mean drainage
durations of chest and axillary were 7.73 day and 8.09 days respectively, and mean length of hospital stay (LOS) was
20.00+16.72 days. The median tumor size in the LD flap group was significantly bigger than that of the MRM group (15 vs.
3.6 cm, p<0.001). There were no significant differences between MRM and LD flap in terms of gender, age, marital status,
BMI, Hct, Albor underlying diseases.
Conclusion : LD flap is a safe option for autologous breast reconstruction, although donor-site complications are often
observed. A larger series to investigate the results and adverse effects of this procedure is needed.
Keywords : Latissimus Dorsi myocutaneous flap, LD Flap, Breast reconstruction
