Aesth Plast Surg (2008) 32:558559 DOI 10.

1007/s00266-008-9124-z

CASE REPORT

A Case of Postmastectomy Defect Reconstructed Using a Laterothoracic Bilaterally Pedicled V-Y Advancement Flap
Horia R. Siclovan

Received: 3 February 2008 / Accepted: 7 February 2008 / Published online: 5 March 2008 Springer Science+Business Media, LLC 2008

Abstract Background The reconstruction of major defects of the trunk is generally achieved by means of pedicled or free musculocutaneous aps, but for less extensive defects, local aps or skin grafts are currently used. The bilaterally pedicled V-Y advancement ap differs from the traditional V-Y advancement ap and was described for soft tissue reconstruction in the face. In our unit, the bilaterally pedicled V-Y advancement ap is the most used local ap for face reconstruction, and our aim was to use it in a different location. Methods In this case report we present a postmastectomy defect reconstructed with good results using the bilaterally pedicled V-Y advancement ap. Results The ap healed without further problems, and a good aesthetic result was obtained. Conclusion The bilaterally pedicled V-Y advancement ap is reliable and easy to harvest, and not only for face reconstruction. Its versatility and plasticity allow its use for the reconstruction of many defects at varying locations. Keywords Bilaterally pedicled V-Y advancement ap

lateral bridges. It differs from traditional V-Y advancement aps in that it does not rely on the classic subcutaneous vertical pedicle that is sectioned from top to bottom to improve advancement of the skin island based only on its bilateral pedicles. Case Report A 53-year-old woman underwent left mastectomy for breast cancer; 6 months later she presented in our service with an axillary round defect 5 cm in diameter. A bilaterally pedicled V-Y advancement ap was designed on the patients left laterothoracic region. The recipient site determined the size of the ap (Fig. 1). An isosceles triangle results when the ap is designed. The height (H) of the triangle which is the length of the V-Y ap is calculated as follows: H
D=2 tan a/2

The bilaterally pedicled V-Y advancement ap was introduced by Pontes in 2002 [1] with clinical applications for face reconstruction. In this report we present a postmastectomy defect case that was reconstructed with good results using the bilaterally pedicled V-Y advancement ap based on two subcutaneous pedicles that vascularize the skin island through subdermal plexus
H. R. Siclovan (&) Med Art Clinics, P.O. Box 285359, Riyadh 11323, Saudi Arabia e-mail: hsiclovan@gmail.com

where D is the defects diameter and a is the triangles angle (opposite the defect). The a angle is a very important issue. For its determination we must consider the location of the defect and the elasticity of the surrounding tissue. We must also consider that the smaller the angle, the longer the ap design. According to the literature, the a angle should measure 20-40 [2]. In our case the defects diameter was 5 cm, the a angle was 30 and the height of the triangle (the length of the V-Y ap) was about 10 cm. The recipient site was debrided to the depth of the pectoralis muscle. The incisions of the lateral limbs of the ap were done by beveling outward just until the subdermal plane, continuing the dissection in this plane by undermining both pedicled aps, dissecting and elevating the whole central part of the ap from its bed, and

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Fig. 1 A 53-year-old woman underwent reconstruction using a laterothoracic bilaterally pedicled V-Y advancement ap for an axillary postmastectomy defect

Fig. 2 Two-month postoperative view. The ap survived completely and the functional and aesthetic results were good

extending the dissection with scissors laterally under the pedicled aps to create and free the inferior aspect of the pedicles. The tip of the V was freed, the top of the ap was pulled, and blunt dissection was performed to the lateral pedicles until the ap covered the defect without tension. The skin was closed with nylon 30 stitches, creating a classic Y pattern. Two weeks later the stitches were removed and the ap healed without complications. The aesthetic result was good (Fig. 2). We believe that the bilaterally pedicled V-Y advancement ap is reliable and easy to harvest, not only for face

reconstruction but for other areas as wells. Its versatility and plasticity allow the reconstruction of many defects at different locations of the body.

References
1. Pontes L, Ribeiro M, Vrancks JJ, Guimaraes J (2002) The new bilaterally pedicled V-Y advancement ap for face reconstruction. Plast Reconstr Surg 109:18701874 2. Andrades PR, Calderon W, Leniz P, Bartel G, Danilla S, Benitez S (2005) Geometric analysis of the V-Y advancement ap and its clinical applications. Plast Reconstr Surg 115:15821590

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