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Ann Thorac Surg 2006;82:752-755
© 2006 The Society of Thoracic Surgeons

How to do it

Use of the Extended V-Y Latissimus Dorsi Myocutaneous Flap for Chest Wall Reconstruction in Locally Advanced Breast Cancer

Evan Woo, MRCS (Edin), M Med (Surg)a, Bien-Keem Tan, FRCS (Edin)a,*, Heng Nung Koong, FRCS (Edin & Glasg)b, Allen Yeo, FRCS (Edin), M Med (Surg)c, Mun Yew Patrick Chan, FRCS (Edin)d, Colin Song, FRCS (Edin)a

a Department of Plastic Surgery, Singapore General Hospital, Singapore
b Department of General Surgery, Singapore General Hospital, Singapore
c Department of Surgical Oncology, National Cancer Centre, Singapore
d Department of General Surgery, Tan Tock Seng Hospital, Singapore

Accepted for publication July 11, 2005.

* Address correspondence to Dr Tan, Department of Plastic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608. (Email: bienkeem{at}singnet.com.sg).

The extended V-Y latissimus dorsi myocutaneous flap described by Micali and Carramaschi provides an innovative method of closing large anterior chest defects after resection of breast cancer. The technique provides robust chest wall coverage that is able to withstand immediate postoperative radiotherapy. The aim of this article is to confirm the usefulness of the flap's design and describe modifications to the technique. The modifications to technique include: a curvilinear design that recruited more skin for closure in patients with wounds extending laterally or superiorly, routine transposition of latissimus dorsi insertion inferio-medially onto the chest wall to maximize pedicle reach, and the use of small split skin grafts or delayed primary closure if there was tension in closing. Twelve patients who underwent resection of locally advanced breast cancer had immediate chest wall reconstruction with the extended V-Y latissimus dorsi musculocutaneous flap. The V to Y design of the flap's cutaneous island allowed primary closure of chest wound and donor defect.

There were no instances of chest wound dehiscence. The chest wounds healed, allowing patients to undergo adjuvant radiotherapy in a mean time interval of 6 weeks after surgery.




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J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1242 - 1243.
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