Use of the Extended V-Y Latissimus Dorsi Myocutaneous Flap for Chest Wall Reconstruction in Locally Advanced Breast Cancer Evan Woo, MRCS (Edin), M Med.

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Use of the Extended V-Y Latissimus Dorsi Myocutaneous Flap for Chest Wall Reconstruction in Locally Advanced Breast Cancer Evan Woo, MRCS (Edin), M Med (Surg), Bien-Keem Tan, FRCS (Edin), Heng Nung Koong, FRCS (Edin & Glasg), Allen Yeo, FRCS (Edin), M Med (Surg), Mun Yew Patrick Chan, FRCS (Edin), Colin Song, FRCS (Edin) The Annals of Thoracic Surgery Volume 82, Issue 2, Pages 752-755 (August 2006) DOI: 10.1016/j.athoracsur.2005.07.030 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Summary of patients. The Annals of Thoracic Surgery 2006 82, 752-755DOI: (10.1016/j.athoracsur.2005.07.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schematic representation of the extended V-Y latissimus dorsi design and operative procedure. (A) Flap planning. The wounds are depicted by the squares. Straight-cut flap design is depicted by dotted lines, whereas the curvilinear design is depicted by dashed lines. Note how the curvilinear design recruits more skin area to provide cover for a more laterally situated wound. (B) The extended V-Y latissimus dorsi flap transposed anteriorly without disinsertion of the pedicle. Note how the transposition of the flap causes its long axis to be vertical. (C) The extended V-Y latissimus dorsi flap after disinsertion of the pedicle. Disinsertion allows the long axis of the flap to be horizontal, which is necessary for insetting. Note the sutures anchoring the insertion of the latissimus dorsi to the ribs indicated by the arrow. This prevents accidental avulsion of the pedicle. The Annals of Thoracic Surgery 2006 82, 752-755DOI: (10.1016/j.athoracsur.2005.07.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Case 5 patient: a 66-year-old woman who presented with locally advanced breast tumor measuring 10 cm in diameter. (A) This chest wound was closed by the extended V-Y latissimus dorsi flap design. (B, C) Good range of motion can be achieved with intensive physiotherapy starting 3 weeks postoperatively. The Annals of Thoracic Surgery 2006 82, 752-755DOI: (10.1016/j.athoracsur.2005.07.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions