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.