L-shaped (Boomerang or Bilobed) Latissimus Dorsi (LD) Flap for Coverage of Large Radical Mastectomy Defects: A Viable Alternative to Free Flaps.

Abstract

Introduction: While free flaps are often the standard for large defects after radical mastectomies, their use can be limited by facility, availability or patient comorbidities. This study introduces and evaluates an L-shaped boomerang latissimus dorsi (LD) flap as a reliable alternative for covering large post-mastectomy defects, aiming for primary closure of both the donor and recipient sites, without the need for skin grafts.

Materials and methods: This retrospective audit included 21 patients aged 18 and above who underwent breast reconstruction with an L-shaped LD flap between January 2020 and January 2023 at a tertiary care cancer institute. Data collected included age, BMI, cancer stage, tumour size, comorbidities, defect and flap sizes, and postoperative outcomes such as healing, complications (seroma, hematoma, dehiscence, flap necrosis), and delay in adjuvant therapy.

Results: All 21 patients successfully underwent reconstruction with the boomerang LD flap, and all donor sites healed well, resulting in an inverted L-shaped scar, with 2 cases of marginal necrosis, 4 of seroma and 1 case of suture line dehiscence. The mean drain indwelling period was 7 days, and the average hospital stay was 5 days.

Conclusion: The L-shaped or boomerang design of the Latissimus Dorsi musculocutaneous flap offers a robust and effective method for reconstructing large breast defects following radical mastectomies.