Abstract
Autologous breast reconstruction by the latissimus dorsi musculocutaneous (LD) flap has several problems including scarcity of the tissue and postoperative atrophy or conspicuous movement of muscles. A modification of the LD flap based on a re-evaluation of the intramuscular and perforating vascular anatomy focused on the intercostal vascular system. The authors’ anatomical study confirmed the following technical improvements: (1) Splitting of the muscle oriented along the 10th posterior intercostal artery; (2) Siting the axis of the flap on the center of the 10th lateral intercostal artery perforator to obtain ample subcutaneous fat cranial to the iliac crest; and (3) Enclosing the dermo-adipofascial flap around the split muscular pedicle. The lateral intercostal perforator oriented LD flaps, which might be called the lateral perforator LD flaps, were applied for the patients who desired reconstruction without implants. The results revealed the consistent volume of tissue and shape and less donor site morbidity. Our modifications can be used to enhance the three-dimensional potential of the LD flap in autologous breast reconstruction.
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References
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Acknowledgment
The authors deeply appreciate Dr. Nobuaki Imanishi, Associate professor of Department of Anatomy, Keio University, Tokyo, for supplying fresh human cadavers and angiographies, Dr. Kiyonori Harii, Chief Professor of Department of Plastic and Reconstructive Surgery, Kyorin University, Tokyo, for supervising the original study of this chapter, and Dr. Hideo Nakajima, the former Associate Professor of Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, for inspiring the basic idea.
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Minabe, T., Yamakawa, T. (2016). Lateral Intercostal Artery Perforator Oriented Latissimus Dorsi Flap: Anatomical Study and Application in Autologous Breast Reconstruction. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_6
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DOI: https://doi.org/10.1007/978-3-319-18726-6_6
Publisher Name: Springer, Cham
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