Acquired Breast Deformity, Breast Cancer, Post Burn Breast Deformities
Conditions
Keywords
Breast reconstruction, Endoscopic-assisted surgery, Latissimus dorsi flap, Myocutaneous flap, Minimally invasive surgery, Donor-site morbidity
Brief summary
This prospective single-arm case series evaluates the feasibility, safety, and clinical outcomes of endoscopic-assisted latissimus dorsi musculocutaneous flap harvest for breast reconstruction. The study includes women with post-oncologic or post-burn breast deformities requiring autologous tissue reconstruction with a skin paddle measuring 6 cm or less in its greatest dimension. The primary objective is to assess the feasibility of minimally invasive flap harvest while preserving reconstructive effectiveness. Secondary outcomes include flap viability, operative time, postoperative pain, drain duration, donor-site morbidity, scar quality, complications, and patient satisfaction. Patients are followed for one year after surgery, with clinical assessment and patient-reported outcome measures used to evaluate reconstructive and aesthetic results.
Detailed description
The latissimus dorsi (LD) musculocutaneous flap is a well-established option for breast reconstruction because of its reliable vascular anatomy and versatility. However, conventional flap harvest requires a long dorsal incision that may result in visible scarring, postoperative pain, seroma formation, and donor-site morbidity. Endoscopic-assisted harvest has been developed to minimize donor-site scarring while preserving the advantages of the conventional technique. Although endoscopic harvest of the muscle-only flap has been increasingly reported, evidence regarding endoscopic-assisted harvest of the musculocutaneous latissimus dorsi flap remains limited because inclusion of a skin paddle presents additional technical challenges. This prospective case series was conducted at Kasr Al Ainy Hospital, Cairo University, to evaluate the feasibility, safety, and clinical outcomes of endoscopic-assisted latissimus dorsi musculocutaneous flap harvest in women requiring breast reconstruction following breast cancer treatment or burn deformity. Eligible patients required autologous reconstruction using a musculocutaneous flap with a skin paddle measuring no more than 6 cm in its greatest dimension and had an intact latissimus dorsi muscle and thoracodorsal vascular pedicle. All procedures were performed under general anesthesia using an endoscopic-assisted technique through a limited donor-site incision. The flap was harvested under endoscopic visualization while preserving the thoracodorsal vascular pedicle, followed by transfer of the flap to the breast defect. Standard postoperative management and follow-up were performed for one year. Outcome measures include flap viability, operative time, postoperative pain, drain output and duration, donor-site and recipient-site complications, scar quality assessed using the Vancouver Scar Scale, and patient-reported satisfaction measured using the BREAST-Q questionnaire. The study aims to determine whether endoscopic-assisted harvest of the latissimus dorsi musculocutaneous flap provides reliable breast reconstruction with reduced donor-site morbidity and improved cosmetic outcomes compared with those historically reported for conventional open harvest.
Interventions
PROCEDUREEndoscopic-Assisted Latissimus Dorsi Musculocutaneous Flap Harvest
Participants underwent breast reconstruction using an endoscopic-assisted latissimus dorsi musculocutaneous flap harvested through a limited donor-site incision. Endoscopic visualization was used to facilitate subcutaneous and submuscular dissection while preserving the thoracodorsal vascular pedicle and minimizing donor-site scar length. After flap harvest, the musculocutaneous flap was transferred to the breast defect and inset according to the reconstructive requirements of each patient. Standard postoperative care and follow-up were provided for all participants.
Sponsors
Kasr El Aini Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
All enrolled participants undergo endoscopic-assisted latissimus dorsi musculocutaneous flap harvest for breast reconstruction. Outcomes are assessed prospectively without a comparison group.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Female patients aged 18 to 65 years. * Patients with post-oncologic or post-burn breast deformities requiring autologous breast reconstruction. * Patients requiring reconstruction with a latissimus dorsi musculocutaneous flap incorporating a skin paddle measuring ≤6 cm in its greatest dimension. * Defects considered unsuitable for correction with local tissue rearrangement. * Intact latissimus dorsi muscle and thoracodorsal vascular pedicle. * Ability to provide written informed consent and comply with the study follow-up schedule.
Exclusion criteria
* Age younger than 18 years or older than 65 years. * Body mass index (BMI) \>35 kg/m². * Uncontrolled medical comorbidities or immunosuppressive conditions. * Absence of a skin defect requiring reconstruction. * Cutaneous defects requiring a skin paddle \>6 cm in its greatest dimension. * Inadequate oncologic control or evidence of active disease. * Ongoing adjuvant chemotherapy or radiotherapy at the time of reconstruction. * Previous thoracic surgery or trauma compromising the latissimus dorsi muscle or thoracodorsal vascular pedicle. * Inability or unwillingness to comply with study follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with successful endoscopic-assisted latissimus dorsi musculocutaneous flap harvest and reconstruction without conversion to open technique | During surgery through 30 days postoperatively | Success was defined as completion of endoscopic-assisted harvest and transfer of the latissimus dorsi musculocutaneous viable flap without conversion to a conventional open harvest. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain | Up to 30 days after surgery | Postoperative pain was assessed using the Numeric Rating Scale (NRS), with scores ranging from 0 (no pain) to 10 (worst imaginable pain). |
| Operative time | During the operation | Total operative time, measured in hours from skin incision to completion of wound closure. |
| Donor-site morbidity | Up to 6 months after surgery | Donor-site morbidity was evaluated by recording postoperative complications including seroma, hematoma, wound infection, wound dehiscence, and other donor-site complications. |
| Donor-site scar length | up to 6 months after surgery | Final donor-site scar length was measured in centimeters. |
| Patient satisfaction | One year after surgery | Patient-reported satisfaction with breast reconstruction and donor-site appearance was assessed using the BREAST-Q® Reconstruction Module. |
| Utility of geometric scar prediction approximation | Preoperative planning compared with one-year postoperative scar assessment | The accuracy of the proposed geometric approximation for predicting final donor-site scar length was evaluated by comparing the estimated scar length with the measured postoperative scar length. |
| Length of hospital stay | Up to 2 weeks after surgery | Length of postoperative hospital stay, measured in days from surgery until hospital discharge. |
| Time to drain removal | Up to 30 days after surgery | Time from surgery until removal of the surgical drain, measured in days. |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORAdel M Wilson, MD
Kasr El Aini Hospital
Outcome results
None listed