Invited Discussion on: Extended Latissimus Dorsi Kite Flap (ELD-K Flap): Revisiting an Old Place for a Total Autologous
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Extended Latissimus Dorsi Kite Flap (ELDK Flap): Revisiting an Old Place for a Total Autologous Breast Reconstruction in Patients With Medium to Large Breasts Michele A. Shermak1,2
Received: 10 October 2020 / Accepted: 14 October 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The latissimus musculocutaneous flap serves as a major workhorse for reconstruction in plastic surgery. Since 1980, when Dr. Maxwell published the translated version of Tansini’s original transcript from 1896 on latissimus flap reconstruction for mastectomy defects, the latissimus flap has been reliably utilized for reconstructing large complex defects from head to toe [1]. All board-certified plastic surgeons have been well schooled on the anatomy and harvest of this flap, and can employ it for many difficult reconstructive problems, either pedicled or free. For breast, the flap may be used for primary reconstruction after partial or total mastectomy, but it tends to fall behind abdominalbased autologous reconstruction in prevalence when considering primary autologous breast reconstruction. The reasons for this include the lack of volume the latissimus provides for a fully autologous reconstruction, most often relying on the volume and predictability of an adjunctive implant; the back scar and concerns about physical disability and cosmetic deformity; and the lateral or prone positioning required for harvest requiring added operative time, exposure, and need for patient protection. The latissimus is more often used for complicated scenarios such as secondary reconstruction to salvage radiation damage or
& Michele A. Shermak [email protected] 1
The Johns Hopkins Department of Plastic Surgery, Baltimore, MD, USA
2
Lutherville, MD, USA
failed implant reconstruction, or for women with co-morbidities that increase risk of healing problems with other reconstructive options. The latissimus provides hardy tissue coverage and paired with an implant provides the necessary volume and contour for an aesthetic, symmetrical reconstruction. Many women, however, refuse implantbased reconstruction in response to what they have read/heard about concerning issues related to implants–Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), Breast Implant Illness (BII), Capsular Contracture, as well as the impending need for future implant replacement. These concerns have limited the applicability of latissimus breast reconstruction. Because the latissimus flap is so reliable, flap design has evolved to enhance aesthetic reconstruction, from improved identification of blood supply which allows for reduced to no muscle harvest and potential functional d
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