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Laparoscopic harvest of omental flap for immediate breast reconstruction: An evolved modality for volume replacement
1016 34. Laparoscopic harvest of omental flap for immediate breast reconstruction: An evolved modality for volume replacement David Westbroek, M. Douek Guy’s and St Thomas’ Hospitals, Cancer Division, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RN Laparoscopic harvest of omental flap (LHOF) in immediate breast reconstruction has the benefit of minimal donor site morbidity or scars, no residual loss of function, stable and natural aesthesis tolerant of adjuvant radiotherapy and equivalent oncologic safety. The drawback has been the adequacy of flap volume relative to the defect following partial (or complete skin sparing) mastectomy. The evolution of 64 - row multi-detector computer tomography (MDCT) exploits multi-planar reconstruction and selective volume rendering views, thus enabling accurate anatomic delineation and volumetric analysis. We aim to highlight the evolution and application of minimal access surgery and MDCT in patients undergoing reconstruction following breast conservation or mastectomy in the immediate setting. Method: Medline, EMBASE, Cochrane library and other online databases were searched over the period January 2000 to December 2010 to
ABSTRACTS identify English language articles relating to LHOF in post-mastectomy breast reconstruction. Manual searches via reference lists identified additional relevant articles. Reports were selected using a predetermined protocol which included studies with clinical outcomes on at least two patients. Results: A total of three peer reviewed articles fulfilled the inclusion criteria reporting on a total of 110 patients. The largest and most recent unselected, retrospective case series reported by Zaha et al. had 96 patients (89 pedicled and 7 free omentum flaps) with a median follow-up of 38 months (2e80 months); laparoscopic harvest time of 65 minutes (45– 90); 0% conversion to open laparotomy and 1% total flap loss. The complication rate was 8.3% including 5.2% fat necrosis and 1.0% incisional hernia rate. A third of patients (32.3%) underwent postoperative radiotherapy with no discernable loss of volume at follow-up; Jimenez et al. in their free flap series report a median flap weight of 477grams (325–650). Conclusion: LHOF reconstruction of partial or complete mastectomy defects is feasible and efficacious in restoring volume and symmetry. Adjunctive use of MDCT planning could assist in patient selection and enhance predictability of aesthetic outcome.
ABSTRACTS identify English language articles relating to LHOF in post-mastectomy breast reconstruction. Manual searches via reference lists identified additional relevant articles. Reports were selected using a predetermined protocol which included studies with clinical outcomes on at least two patients. Results: A total of three peer reviewed articles fulfilled the inclusion criteria reporting on a total of 110 patients. The largest and most recent unselected, retrospective case series reported by Zaha et al. had 96 patients (89 pedicled and 7 free omentum flaps) with a median follow-up of 38 months (2e80 months); laparoscopic harvest time of 65 minutes (45– 90); 0% conversion to open laparotomy and 1% total flap loss. The complication rate was 8.3% including 5.2% fat necrosis and 1.0% incisional hernia rate. A third of patients (32.3%) underwent postoperative radiotherapy with no discernable loss of volume at follow-up; Jimenez et al. in their free flap series report a median flap weight of 477grams (325–650). Conclusion: LHOF reconstruction of partial or complete mastectomy defects is feasible and efficacious in restoring volume and symmetry. Adjunctive use of MDCT planning could assist in patient selection and enhance predictability of aesthetic outcome.