Arch Hand Microsurg.  2019 Dec;24(4):388-393. 10.12790/ahm.2019.24.4.388.

Using a Pedicled Latissimus Dorsi Musculocutaneous Flap to Treat Infective Costochondritis Following Breast Reconstruction Using an Implant

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. ohdeuk1234@hanmail.net

Abstract

Infectious costochondritis seldom occurs after breast reconstruction. The treatment requires wide debridement, appropriate wound cover, and antibiotic therapy. A 53-year-old female patient was referred due to an unhealed right breast wound. She had undergone right skin-sparing mastectomy followed by breast reconstruction with an implant. Pseudomonas aeruginosa was cultured from the wound discharge, and a computed tomography showed fluid collection underneath the pectoralis muscle with connection to the external opening as well as degenerated T4-T6 costal cartilages. Wide excision of infected tissue and costal cartilages followed by a pedicled latissimus dorsi musculocutaneous flap coverage were performed. The mastectomy wound allows a wider surgical view to prepare thoracodorsal vessels, and the harvesting the latissimus dorsi musculocutaneous flap can be more easily performed without excessive traction force or damage on pedicles. The coverage of pedicled flap was successful and the patient was injected antibiotics intravenously for 3 weeks without any postoperative complications.

Keyword

Latissimus dorsi; Costochondritis; Breast reconstruction

MeSH Terms

Anti-Bacterial Agents
Breast*
Costal Cartilage
Debridement
Female
Humans
Mammaplasty*
Mastectomy
Middle Aged
Myocutaneous Flap*
Pectoralis Muscles
Postoperative Complications
Pseudomonas aeruginosa
Superficial Back Muscles*
Surgical Flaps
Traction
Wounds and Injuries
Anti-Bacterial Agents

Figure

  • Fig. 1 Preoperative clinical photo.

  • Fig. 2 Preoperative computed tomography. (A) A fluid collection underneath the pectoralis muscle (white arrow) with connecting tracts to the external opening (white arrowhead). (B) Degenerated T4–T6 costal cartilages (white arrow).

  • Fig. 3 Intraoperative photo: the pectoralis major muscle and 3 tracts to infected costal cartilage were resected.

  • Fig. 4 (A) Dissected thoracodorsal vessels. (B) The tendon inserted into the latissimus dorsi musculocutaneous was detached.

  • Fig. 5 Postoperative 4-month photographs without any complications.


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