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.