Application Of Latissimus Dorsi Musculocutaneous Flap Reconstruction In Refractory Mastitis After Failure Of Conservative Treatment

Background:Non-lactational mastitis(NLM)is a chronic nonspecific inflammation that occurs in the non-lactating period.The main clinical manifestations of NLM are breast mass and abscess.Fistulas,sinuses or ulcers may develop later in the disease,which are often persistent and difficult to heal on their own.Currently,clinical studies on the severity of NLM are limited and lack of uniform standards.In this study,based on clinical practice,NLM with no conservative treatment,large area of local skin accompanied by redness,rupture,and accumulation of inflammation in the breast tissue behind the nipple and areola and multiple breast quadrangles indicated by breast color Doppler ultrasound was defined as refractory mastitis with failure of conservative treatment.Compared with drug therapy and traditional Chinese medicine therapy,surgical treatment can achieve better therapeutic effect in the short term,which is the main treatment method at present.Traditional incision and drainage for the treatment of NLM is limited and the treatment time is long,and the local resection of inflammatory lesions is difficult to meet the needs of patients for the postoperative appearance of the breast.In view of the fact that this disease tends to occur in young and middle-aged women,patients have a stronger need to maintain the appearance of the breast after surgery.The clinical efficacy of breast reconstruction with latissimus dorsi musculocutaneous flap for refractory mastitis that failed conservative treatment is worth studying.Objective:To investigate the clinical effect of latissimus dorsi musculocutaneous flap reconstruction for refractory mastitis that failed conservative treatment.Methods:Retrospective analysis was performed on the clinical data of 10 refractory mastitis patients who underwent giant inflammatory mass resection and immediate reconstruction of latissimus dorsi musculocutaneous flap after resection of subcutaneous residual glands and failed conservative treatment in the Department of Breast Surgery of China-Japan Union Hospital of Jilin University from October 2020 to June 2022.Patients meeting the exclusion criteria were selected to conduct preoperative and postoperative questionnaire surveys on the corresponding modules of BREAST-Q,and the results were statistically analyzed.Results:All the 10 patients with refractory mastitis survived without abnormal postoperative bleeding,vascular crisis,subcutaneous hematoma,infection,subcutaneous effusion in the recipient area,ischemic necrosis of nipple and areola,or paresthesia in this area.The incisions were all grade A healing.One patient developed seroma after back surgery and recovered 3 months later after adequate drainage.The mean follow-up time was 17.2 months.During the follow-up,the reconstructed breast was full in shape,with natural sagging,linear scar remained on the back,and the motor function of the upper limb on the affected side was not significantly affected.No recurrence of mastitis occurred.Nine treated patients underwent BREAST-Q questionnaire survey,and the scores of mental health and chest and body health in the postoperative group were higher than those in the preoperative group(P<0.05),the body health score of the postoperative group was lower than that of the preoperative group(P<0.05),there were statistically significant differences between the two groups in mental health,chest body health and shoulder and back body health.Sexual health scores in the postoperative group were higher than those in the preoperative group(P>0.05),but the difference was not statistically significant.The median postoperative breast satisfaction was 78(inter-quartile range: 11),74(9.5)for back,92(11)for breast surgeon and 91(12)for medical team.Conclusions:Latissimus dorsi musculocutaneous flap reconstruction is safe and effective in the treatment of refractory mastitis that failed conservative treatment.After breast reconstruction,it can achieve good cosmetic effect,good patient satisfaction,and significantly improve the mental health and physical health of patients,which is worthy of clinical promotion.