Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap

Background: Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. Methods: In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Results: Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. Conclusions: The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management. (Plast. Reconstr. Surg. 127: 2186, 2011.)

The use of strategic visioning to enhance local tourism planning in periphery communities

Tourism has had a profound impact upon destinations worldwide, and although this impact has been positive for many destinations, there are numerous examples where tourism has adversely impacted upon the environment and social fabric of the destination community (Coccossis 1996; Murphy 1985). The negative impacts of tourism have been attributed, among other things, to inadequate or non-existent planning for development (Gunn 1994; Hall2000). This has led to increased calls for tourism planning to offset some of the negative impacts that tourism can have on the destination community. While a number of approaches have been advocated, a collaborative philosophy, based on the principles of sustainability, is more likely to result in acceptable and successful policies and programmes for tourism destinations (Farrell1986; Jamal & Getz 1995; Maitland 2002; Minca & Getz 1995). Such an approach focuses on cooperation and broader based participation in tourism planning and decision-making between stakeholders to lead to agreement on planning directions and goals, with one of the primary objectives of collaborative arrangements being to develop a strategic vision for a destination (Bramwell & Lane 2000). [Extract from introduction]