Lymphatic drainage study after latissimus dorsi flap breast reconstruction

Background Recurrence of breast cancer to latissimus dorsi (LD) flap donor site is a very rare condition and as a result few data are currently available on its possible causes. The aim of the study was to investigate the role of LD flap transfer in lymphangiogenesis and connection to the pre-existing lymphatic network after mastectomy and axillary lymph-nodes dissection, and the lymphatic drainage involvement in local relapse to flap donor site. Methods Lymphoscintigraphy was performed on subgroup of 10 patients who had previously undergone modified radical mastectomy, axillary lymph-nodes dissection and pedicled LD flap reconstruction. Lymphatic drainage was imaged by static gamma camera acquisitions after two intradermal injections of 37MBq 99mTc-Nanocoll® on residual breast skin and latissimus dorsi skin paddle, respectively. Results In 8 cases (80%) the residual breast skin showed fast lymphatic drainage directed only towards the ipsilateral axilla, while in 2 cases (

Background Recurrence of breast cancer to latissimus dorsi (LD) flap donor site is a very rare condition, and as a result, few data are currently available on its possible causes. The aim of the study was to investigate the role of LD flap transfer in lymphangiogenesis and connection to the preexisting lymphatic network after mastectomy and axillary lymph node dissection and the lymphatic drainage involvement in local relapse to flap donor site. Methods Lymphoscintigraphy was performed on subgroup of ten patients who had previously undergone modified radical mastectomy, axillary lymph node dissection, and pedicled LD flap reconstruction. Lymphatic drainage was imaged by static gamma camera acquisitions after two intradermal injections of 37 MBq 99mTc-Nanocoll® on residual breast skin and LD skin paddle, respectively. Results In eight cases (80 %), the residual breast skin showed fast lymphatic drainage directed only toward the ipsilateral axilla, while in two cases (20 %), it was also seen to the internal mammary nodes. LD skin paddle showed slower drainage in all cases but 1, where no visible drainage was observed within 2 h after injection. Conclusions Although a small case series is the study limitation, our findings suggested that the LD flap harvest can promote a preferential route of lymphatic drainage in the axillary region and could be involved in a metastatic spread to the dorsum because of the new tissue plane opening. The direct communication created between recipient and donor sites could have lead to cell cancer transfer to the donor site either by lymphatic or a contiguity pathway.Level of Evidence: Level V, diagnostic study. © 2014 Springer-Verlag Berlin Heidelberg.