Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi...Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.展开更多
Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented...Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.展开更多
Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aestheti...Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.展开更多
The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experienc...The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.展开更多
Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was...Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.展开更多
Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be ...Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.展开更多
文摘Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.
文摘Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.
文摘Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.
文摘The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.
文摘Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.
文摘Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.
