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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Limberg flap in mastectomy T-junction necrosis: an underutilised technique
  1. Adam Ofri1,2,
  2. Davina Von Hagt1 and
  3. Kallyani Ponniah1,3
  1. 1Breast Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
  2. 2Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. 3School of Medicine, University of Notre Dame, Fremantle, WA, Australia
  1. Correspondence to Dr Adam Ofri; adamofri{at}gmail.com

Abstract

The Wise-pattern skin-sparing mastectomy (SSM) is well known for its efficacy in large ptotic breasts, and its safety in facilitating immediate breast reconstruction. An unfortunate sequalae for all SSM techniques is mastectomy skin flap necrosis (MSFN) with a reported range of occurrence of 5%–30%. For the Wise pattern, the common area of wound dehiscence or necrosis is the T-junction. Different techniques have been described in the management of MSFN—ranging from primary closure to local and distant flaps. Full thickness MSFN results in wound breakdown and can expose a prosthesis, subsequently closure must be obtained with potential for the prosthesis to be explanted. To date, there has been no reports in the literature of the usage of a rhomboid flap in an SSM with immediate prepectoral implant. We discuss our experience in the usage of this local cosmetic flap to avoid prosthesis loss and have reviewed the literature regarding MSFN, the application of the rhomboid (Limberg) flap in breast surgery and its applicability in MSFN to preserve underlying prosthesis.

  • breast surgery
  • plastic and reconstructive surgery
  • surgical oncology

https://doi.org/10.1136/bcr-2022-253587

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    Footnotes

    • Contributors All authors were involved in the development of this paper. KP was the managing consultant whom treated the patient and was instrumental in the paper development. DVH developed the original concept of the paper and wrote the provisional paper. AO significantly modified the paper, facilitated the graphical designer and has been the lead in submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.