Objective improvement in upper limb lymphoedema following ipsilaterall latissimus dorsi pedicled flap breast reconstruction – a case series and review of literature

Abbas Khan, Muhammad Adil; Mohan, Arvind; Hardwicke, Joseph; Srinivasan, Karthikeyan; Billingham, Rebecca; Taylor, Christopher; Prinsloo, Daniel

doi:10.1016/j.bjps.2010.06.014

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 64, Issue 5 , Pages 680-684, May 2011

Objective improvement in upper limb lymphoedema following ipsilaterall latissimus dorsi pedicled flap breast reconstruction – a case series and review of literature

Muhammad Adil Abbas Khan
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
- Corresponding author. 10 Harvey Lodge, Admiral Walk, London W9 3TH, UK. Tel.: +44 7863332517.
Arvind Mohan
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
Joseph Hardwicke
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
Karthikeyan Srinivasan
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
Rebecca Billingham
- Lymphoedema Service, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
Christopher Taylor
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK
Daniel Prinsloo
- Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK

Received 25 March 2010; accepted 12 June 2010. published online 14 July 2010.

Summary

Objective

We present a series of three patients whose upper limb lymphoedema (following total oncologic mastectomy and level III axillary clearance) resolved significantly after ipsilateral pedicled latissimus dorsi (LD) flap breast reconstruction.

Methods

A retrospective review of the medical records of patients who had undergone oncologic mastectomy and level III axillary clearance with subsequent LD pedicled flap reconstruction was carried out. Individuals who had undergone review and treatment by the lymphoedema service were identified and patients with incomplete pre- or post-operative records were excluded. A minimum follow-up period of 2 years of conservative therapy, as well as 2 years post-operatively was undertaken.

Results

The rate of improvement of lymphoedema following conservative therapy was, on average, 0.095mL/week and reached a plateau at 2-year follow-up. Following latissimus dorsi flap breast reconstruction, the rate of improvement in lymphoedema increased in all three cases, with an average improvement of 2.55mL/week and remained sustained in the follow-up period.

Conclusion

Pedicled myocutaneous flap reconstruction of the ipsilateral breast proved to be a useful treatment for upper limb lymphoedema in our series. This adds an important dimension to the assessment and treatment of patients with upper limb oedema resulting from mastectomy and axillary clearance.

Keywords: Lymphoedema, Latissimus dorsi, Pedicled flap, Breast reconstruction