Comparison of muscle sparing latissimus dorsi flap vs split thickness skin graft for post burn inframammary fold contracture release in terms of contracture recurrence and breast contour.

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Author(s): Maria Ashraf1 , Ammara Rabbani 2, Mehwish Ihsan 3,Kamran Khalid 4, Yawar Sajjad 5 Zain ul Abidin 6

Received: 29/09/2024 | Revised: 06/12/2024 | Published: 19/12/2024 | Pages: 72-78 | DOI: https://www.ejmanager.com/mnstemps/249/249-1726923095.pdf?t=1763792883


Background: Childhood thermal injuries of anterior chest wall lead to developmental breast abnormalities. Conventional IMF release methods include release of restrictive scars and addition of thick split thickness skin grafts (STSG). However, it may lead to recurrence, poor skin texture and projection deformity.

The pedicled muscle sparing latissimus dorsi (MSLD) flap overcomes these complications. Objective : The aim of this study is to compare the outcomes between these two procedures in terms of contracture recurrence and breast aesthetics and donor site morbidity.

Methodology:

It was a randomized control trail conducted for a period of one year from April, 2023 to April, 2024 at Jinnah burn & reconstructive surgery Centre, Lahore.  Post-pubertal females with small to medium sized breast having post-burn IMF contracture and lower pole projection deformity were included. Lower pole breast reconstruction was done either with MSLD flap or STSG. Patients were randomly allocated to one of the two groups. Three months postoperatively, patients were assessed for breast aesthetics using modified breast aesthetic scale, latissimus dorsi function,  Vancouver scar scale and contracture recurrence.

Results:  Out of Eighteen patients, thirteen were reconstructed with horizontal skin paddle MSLD flap and rest with STSG. Scar characteristic, breast aesthetic score and over all satisfaction were better for MSLD then STSG group (P<0.05).

Contracture recurrence was noted only in two patients and both were reconstructed with thick split thickness skin graft.

Conclusion:  For IMF contracture release, the Pedicled MSLD flap offers an indispensable tool to the arsenal of reconstructive surgeon in post-burn breast reconstruction. It offers superior aesthetic results and minimal recurrence as compared to STSG without increased morbidity.

Key words:

Post-burn breast deformity , Inframammary fold contracture, muscle sparing latissimus dorsi flap, split thickness skin graft.