Extended Latissimus Dorsi Kite Flap (ELD-K Flap): Revisiting an Old Place for a Total Autologous Breast Reconstruction in Patients with Medium to Large Breasts

Casella, Donato; Nanni, Jacopo; Torto, Federico Lo; Barellini, Leonardo; Redi, Ugo; Kaciulyte, Juste; Cassetti, Dario; Ribuffo, Diego; Marcasciano, Marco

doi:10.1007/s00266-020-01990-x

Cited by 6 publications

(4 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An additional important point of consideration is that, since performing primary closure of defects larger than 8 cm is difficult, the design should be implemented so that the length of diagonal line of the bent part of the boomerang flap, which is the widest part, should not exceed 8 cm. The flap designs previously reported were kite-shaped or wing-shaped (22,23), but with these designs it is difficult to hide the scar and the back skin contour may also appear irregular. On the contrary, with our modified LD flap, the vertical scar can be covered or hidden by the brassiere line and the arms.…”

Section: Discussionmentioning

confidence: 99%

Boomerang latissimus dorsi flap in total breast reconstruction: report of three cases

Kang¹,

Park²,

Ryu³

et al. 2022

Gland Surg

View full text Add to dashboard Cite

The latissimus dorsi (LD) flap is one of the most useful techniques for autologous breast reconstruction, especially in Asians. However, for reconstruction of moderate to large volume breasts, it is difficult to achieve the desirable volume and projection with the classic extended LD flap. Although there is the option of concurrent application of an LD flap and a small silicone implant, this may lead to larger volume than desired; furthermore, an increasing number of patients prefer reconstruction with autologous tissue alone. In this case report, we present satisfactory outcomes for moderate to large breast reconstruction in three patients, using the boomerang LD flap technique, a modification of the conventional extended LD flap. The flap was harvested with a transverse incision along the brassiere line and a vertical incision under the arm adjusted for the breast width of the patient. Then, after tunneling to the breast, the autologous reconstructed breast was created with the boomerang LD flap before moving the flap. There were no severe intraoperative or postoperative complications. In one case, linear necrosis of the breast wound was observed and the patient underwent revision operation for treatment. Seromas were not observed in the donor site of the boomerang LD flap and healing was successful. However, the donor site incision was 1.5 to 1.6 times longer than that of the classic LD flap. Boomerang LD flaps allow immediate breast reconstruction after neoadjuvant chemotherapy, without the need of microsurgery or use of abdominal-based flaps and without using silicone implants.

show abstract

Section: Discussionmentioning

confidence: 99%

Boomerang latissimus dorsi flap in total breast reconstruction: report of three cases

Kang¹,

Park²,

Ryu³

et al. 2022

Gland Surg

View full text Add to dashboard Cite

show abstract

“…While the LD is relatively easy to harvest compared to other donor tissues, it is limited by a relatively small tissue volume provided by the flap. One approach to achieve larger volumes is a more aggressive extended LD flap technique which involves harvesting the subcutaneous tissue with the skin paddle, though this carries a higher risk of seroma, contour deformities, and lumbar hernia and is restricted to patients with higher BMI [50][51][52][53][54] . Therefore, LD flaps often require augmentation with an implant to achieve satisfactory aesthetic outcomes [55,56] .…”

Section: Ld Flapsmentioning

confidence: 99%

Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

Shaaban¹,

Gourichon²,

Cruz³

et al. 2023

Plast Aesthet Res

View full text Add to dashboard Cite

Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures. Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability; it can be used independently to replace more invasive flap procedures or implants, or as an adjunct for smaller volume supplementation. The breadth of applications in the breast necessitates diversity in technique and approach, and while there is no universally agreed-upon protocol, basic principles have guided the evolution of some commonly adopted tenets. Broadly, fat grafting outcomes are highly favorable but dependent on patient and procedure factors, requiring learned patient selection and expertise in recipient site assessment. Common complications from fat grafting, such as fat necrosis and the development of nodules, are particularly troublesome for post-oncologic patients, requiring considerable pre-surgical consultation for patient education and managing expectations. In addition to volume and contour augmentation, fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or post-mastectomy pain syndrome, improved skin quality and reduced fibrosis following radiation, and possible anti-tumorigenic effects. New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma. Preclinically, research towards safe and effective regenerative medicine approaches is actively underway, with the ultimate goal of achieving predictable and increased graft retention, reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.

show abstract

“…In order to implant an endoscopic illuminated breast retractor and energy device (long pen diathermy), the surgical assistant first lifted the surrounding skin using a surgical minor wound retractor (Model nm-di-786813, Sculpo endoscopic retractor with a channel for endoscopes, New Med Supplies, Pakistan), with an integrated 10mm camera (Figs. 8,9,10).…”

Section: Latissimus Dorsi Muscle Flap Harvestingmentioning

confidence: 99%

“…Despite its widespread use, two limitations of the Extended LD muscle flap for reconstructing the breast are the conspicuous sightly remaining donor site scar and the modest volume of the muscle flap, which often necessitates breast implant augmentation to provide the best cosmetic outcome [10,11].…”

Section: Introductionmentioning

confidence: 99%

Combined Endoscopic Latissimus Dorsi Flap with Fat Graft versus Extended Latissimus Dorsi Flap for Breast Reconstruction

Barakat

Elbadawy

Abdelsalam

et al. 2022

The Egyptian Journal of Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

Background: Various breast reconstruction techniques after mastectomy have been developed over the last few years based on the idea of volume replacement, either by autologous flaps, such as Latissimus dorsi (LD) flap or device-based techniques, such as implants. Combined Endoscopic LD flap with fat graft is an advanced technique that enhances the muscle volume and lower the postoperative complications.Objectives: Comparison between combined Endoscopic LD Flap with fat graft versus extended LD Flap for breast reconstruction in breast cancer patients regarding the aesthetic outcome, and patient satisfaction on long term results.Patients and Methods: There were 40 female patients with early invasive breast carcinoma, including stages I, II, and III A, in accordance with the American Joint Committee on Cancer (AJCC) staging system (1) in this comparative analysis. Twenty patients each performed skin sparing mastectomy and immediate reconstruction using the conventional extended (LD) flap technique and the endoscopic (LD) flap with fat graft technique. Volume differences between the two studied groups that were evaluated before the surgery and six months after surgery were noted. Additionally, the donor site scar and patient satisfaction with the reconstructed breast were compared.Results: When compared to the conventional group, there was a substantial average volume decrease of the reconstructed breast in the endoscopic group (38.1 versus 18.1 percent, p=0.001). Despite the fact, the endoscopic group's operation took longer time than the conventional group's (203 vs 151 min, p=0.017), which is considered a disadvantage, donor site scar and postoperative seroma was better in the endoscopic group. Conclusion:Endoscopic LD muscle flap with fat graft is better than Extended Latissimus dorsi muscle flap for breast reconstruction regarding overall patient satisfaction and post operative donor site complications. Therefore, endoscopic LD muscle flap with fat graft could represent an alternative technique to Extended LD muscle flap in cases of early invasive breast cancers, including stages I, II, and IIIA, as specified by American Joint Committee on Cancer (AJCC) staging system (1).

show abstract

Extended Latissimus Dorsi Kite Flap (ELD-K Flap): Revisiting an Old Place for a Total Autologous Breast Reconstruction in Patients with Medium to Large Breasts

Cited by 6 publications

References 54 publications

Boomerang latissimus dorsi flap in total breast reconstruction: report of three cases

Boomerang latissimus dorsi flap in total breast reconstruction: report of three cases

Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

Combined Endoscopic Latissimus Dorsi Flap with Fat Graft versus Extended Latissimus Dorsi Flap for Breast Reconstruction

Contact Info

Product

Resources

About