Operation technique
Preoperatively, anatomical landmarks were marked, including bilateral inframammary folds, the tip of the scapula, the iliac crest, the posterior midline, and the border of the LD flap. After the breast surgeon performed the MRM, we estimated the defect size and designed the LD flap.
The patient was turned to the ipsilateral side of the breast, and a transverse incision was made along the bra line. After the pedicle of the thoracodorsal vessels was identified, the subcutaneous layer was dissected. The de-epithelized LD flap was then raised through the tunnel below the axilla to cover the exposed ribs and adjacent soft tissue. The donor site was then closed layer by layer after placing the drainage tubes. The skin graft harvested from the scalp or thigh area was secured to cover the LD flap by using circumferential staples or through suturing to the wound bed.
Subsequently, NPWT was applied, which involved the use of sterile open-cell foam sealed with a plastic adhesive drape and the application of controlled subatmospheric pressure to the wound. The continuous application of negative pressure was achieved using seal-check systems. If an air leak was identified, the leakage site was repaired with a strip of the adherent dressing.