Introduction
Breast cancer is the most common malignancy in women worldwide and is the second most common cause of cancer mortality in Asia.(1) With the increasing incidence of breast cancer, surgical planning for advanced breast cancer has become a challenge because it involves the burden of resection. Breast reconstruction after mastectomy can be performed using many methods, and it depends on soft tissue defect and reconstruction timing.(2) Autologous vascularized tissue graft for breast cancer reconstruction has been performed since the 1970s. The introduction of the latissimus dorsi (LD) flap with its overlying skin island has allowed the restoration of skin and volume loss after mastectomy. The LD flap can be harvested as muscular, musculocutaneous, or bony structures. The advantage of the LD flap is its accessibility, while its disadvantages include visible scars, contour deformity, and inadequate volume.(3) The LD flap can have a maximum dimension of 20 cm × 25 cm, and primary donor site closure can be achieved when the width of the skin paddle is <8–9 cm.(4, 5) In some cases, the defects are too large to be covered using a single flap; in such cases, skin grafts may be suitable for muscle flap coverage.
For the wound reconstruction of large skin defects, surgery with transverse rectus abdominis muscle (TRAM) flaps has demonstrated optimal results. (4) If breast reconstruction with TRAM flaps is unsuitable for the patient, the use of an LD flap with skin graft is an alternative. However, fixing the graft is difficult due to chest wall movement while breathing. To overcome this challenge, negative pressure wound therapy (NPWT) can be applied, which reduces the recipient site’s hematoma formation and holds the skin graft tightly to reduce shear force. Thus, this modality can enhance the survival of skin grafts.(6, 7)
To the best of our knowledge, few reports have detailed the use of NPWT after breast reconstruction using LD flaps and split thickness skin grafts (STSG). In this study, we report our experience with using NPWT after breast reconstruction with LD muscle flap and STSG.