Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Multicenter phaseⅡstudy of apatinib single or combination therapy in HER2-negative breast cancer involving chest wall metastasis

Objective:Breast cancer(BC)with chest wall metastasis(CWM)usually shows rich neovascularization.This trial explored the clinical effect of apatinib on human epidermal growth factor receptor 2(HER2)-negative advanced BC involving CWM.Methods:This trial involved four centers in China and was conducted from September 2016 to March 2020.Patients received apatinib 500 mg/d[either alone or with endocrine therapy if hormone receptor-positive(HR+)]until disease progression or unacceptable toxicity.Progression-free survival(PFS)was the primary endpoint.Results:We evaluated 26 patients for efficacy.The median PFS(mPFS)and median overall survival(mOS)were4.9[range:2.0-28.5;95%confidence interval(95%CI):2.1-8.3]months and 18(range:3-55;95%CI:12.9-23.1)months,respectively.The objective response rate(ORR)was 42.3%(11/26),and the disease-control rate was76.9%(20/26).In the subgroup analysis,HR+patients compared with HR-negative patients had significantly improved mPFS of 7.0(95%CI:2.2-11.8)months vs.2.3(95%CI:1.2-3.4)months,respectively(P=0.001);and mPFS in patients without or with chest wall radiotherapy was 6.4(95%CI:1.6-19.5)months vs.3.0(95%CI:1.3-4.6)months,respectively(P=0.041).In the multivariate analysis,HR+status was the only independent predictive factor for favorable PFS(P=0.014).Conclusions:Apatinib was highly effective for BC patients with CWM,especially when combined with endocrine therapy.PFS improved significantly in patients with HR+status who did not receive chest wall radiotherapy.However,adverse events were serious and should be carefully monitored from the beginning of apatinib treatment.

Determination of Partial Factors of Breast Wall on Top of Sloping Breakwater

By applying the theory of structural reliability, reliability analyses for the stability of a breast wall on the top of a sloping breakwater are carried out. Based on the analyses, the method for determining partial action / load factors and partial resistance factors of breast walls is expounded, and the design expressions with partial factors are given. The values of partial action / load factors and partial resistance factors are recommended preliminarily according to the computation for breast walls with typical cross-sections.

Calculating Method and Verification of Wave Pressure Distribution on the Breast Wall of Mound Breakwater

In this paper, the calculating charts and formulae about wave pressure on the breast wall are derived with seven parameters on the basis of physical model study. The verification shows that the charts agree with the example, and are adopted in the Specifications of Fishery Harbours Breakwater by the Ministry of Agricultures.

Wave Pressure Distribution over the Breast Wall of Mound Breakwater of Small Ports

In this paper, the mechanism of the interaction between the breast wall of mound breakwater and waves is expounded, then some new views and the law of variation of horizontal and vertical wave pressure over the breast wall are put forward. The results of this study have been adopted in the Specifications of Fishery Harbour Breakwater by the Ministry of Agricultures.

Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm;she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.

Long-term survival of the Sister Mary Joseph nodule originating from breast cancer:A case report

BACKGROUND A Sister Mary Joseph nodule(SMJN)is an uncommon cutaneous metastasis found in the umbilicus,indicating an advanced malignancy.SMJNs typically originate from intra-abdominal sources,rarely from breast cancer.Diagnosis suggests a poor prognosis with a median survival of approximately 8 mo after detection.Managing patients with SMJNs is challenging,as most receive limited palliative care only.The optimal strategy for long-term survival of these patients remains unclear.CASE SUMMARY A 58-year-old female,previously diagnosed with right breast cancer 17 years ago and underwent breast-conserving surgery,adjuvant radiotherapy,and endocrine therapy,presented with a 2-cm umbilical nodule.Thirteen years previously,metastases were detected in the right supraclavicular,infraclavicular,hilar,and mediastinal lymph nodes.An umbilical nodule emerged four years before the date of presentation,confirmed as a skin metastasis of primary breast cancer upon excisional biopsy.Despite initial removal,the nodule recurred and grew,leading to her referral to our hospital.The patient underwent extensive excision of the umbilical tumor and immediate abdominal wall reconstruction.Endocrine therapy was continued postoperatively.Five years later,no local recurrence was observed,and the patient continued to work full-time,achieving over 9 years of survival following SMJN diagnosis.CONCLUSION This case study aimed to identify the optimal strategy for achieving extended survival outcomes in patients with SMJN through comprehensive treatment.We presented a case of the longest survival in a patient after undergoing a multidisciplinary treatment regimen.Our findings underscore the significance of adopting a multimodal treatment approach comprising timely and wide excision along with adjunctive therapy.This approach can control the disease,prolong survival,and improve the quality of life in patients with SMJN.

胸壁补偿膜厚度及患者体型特征对乳腺癌调强放疗摆位误差和剂量学的影响

目的:探讨胸壁补偿膜厚度及患者体型特征对乳腺癌患者手术后接受调强放疗治疗的摆位误差及放疗剂量的影响。方法:采用前瞻性研究方法,选取2021年1月至2023年6月阜阳市肿瘤医院肿瘤放疗中心治疗的103例乳腺癌患者,对患者进行锥形束CT检查,分析患者的体质量指数(BMI)、肿瘤位置、胸围、患侧乳腺体积对其摆位误差的影响,分析不同厚度的补偿膜对患者靶区、肺部、心脏、脊髓的放射剂量的影响。结果:不同BMI、不同患侧分布的乳腺癌患者在左右方向上的摆位误差无统计学意义(P>0.05);胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的左右方向摆位误差大于胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05)。不同患侧分布的乳腺癌患者在上下方向上的摆位误差无统计学意义(P>0.05);BMI≥23.1 kg/m^(2)、胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的上下方向摆位误差大于BMI<23.1 kg/m^(2)、胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05);不同BMI水平、不同胸围、不同乳腺体积、不同患侧分布的乳腺癌患者在前后方向上的摆位误差无统计学意义(P>0.05)。左侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的放射治疗计划靶区(PTV)D_(95%)、PTV靶区D_(5%)、左侧肺部V_(20%)、心脏V_(30%)、心脏平均剂量(D_(mean))、脊髓最大剂量(D_(max))、机器跳数(MU)、均匀性指数(HI)测定值比较,差异无统计学意义(P>0.05);采用0.5 cm补偿膜患者的适形度指数(CI)值低于采用1.0 cm补偿膜的乳腺癌患者(P<0.05),右侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的PTV靶区D_(95%)、PTV靶区D_(5%)、右侧肺部V_(20%)、脊髓D_(max)、MU、CI、HI测定值比较,差异无统计学意义(P>0.05)。结论:对于乳腺癌调强放疗患者,BMI、胸围、患侧乳腺体积均与摆位误差有关,采用0.5 cm和采用1.0 cm胸壁补偿膜均可以用于术后放疗,对放疗剂量和加速器跳数影响不大。

沉箱重力式码头现浇混凝土胸墙施工技术探析

为提高沉箱重力式码头中现浇混凝土胸墙施工质量,文中以某地区沉箱重力式码头为例,对沉箱重力式码头现浇混凝土胸墙施工展开分析。实践表明,胸墙施工各结构的实测偏差均在允许偏差范围内,满足该工程项目的质量检验要求。

板桩码头力矩平衡式胸墙模板设计技术及应用

板桩码头的结构形式在国外施工项目中日渐增多,码头的板桩墙与胸墙主要分为陆上施工与水上施工2种形式。陆上施工需要提前填筑围堰,施工措施费用较高且工期延长;水上施工胸墙工序繁琐且施工的安全风险较大、对工程的工期、质量造成一定影响。文章介绍了印尼奥比岛Persada 6B泊位项目的板桩码头胸墙工艺,该项目使用了力矩平衡式底模设计,通过悬吊底模并整体安装的施工工艺,避免了水下焊接作业,且对施工期间的底模力矩平衡条件进行了分析计算,工艺经过项目实践得以顺利实施。

Reirradiation of recurrent breast cancer with proton beam therapy:A case report and literature review

BACKGROUND Locoregional recurrence of breast cancer is challenging for clinicians,due to the various former treatments patients have undergone.However,treatment of the recurrence with systemic therapy and subsequent reirradiation of chest wall is accompanied by increased toxicities,particularly radiation-induced cardiovascular disease.Reirradiation by proton beam therapy(PBT)enables superior preservation of adjacent organs at risk as well as concurrent dose escalation for delivery to the gross tumor.This technology is expected to improve the overall outcome of recurrent breast cancer.CASE SUMMARY A 47-year-old female presented with an extensive locoregional recurrence at 10 yr after primary treatment of a luminal A breast cancer.Because of tumor progression despite having undergone bilateral ovarectomy and systemic therapy,the patient was treated with PBT BE total dose of 64.40 Gy to each gross tumor and 56.00 Gy to the upper mediastinal and retrosternal lymphatics including the entire sternum in 28 fractions.Follow-up computed tomography showed a partial remission,without evidence of newly emerging metastasis.At 19 mo after the PBT,the patient developed a radiation-induced pericardial disease and pleural effusions with clinical burden of dyspnea,which were successfully treated by drainage and corticosteroid.Cytological analysis of the puncture fluid showed no malignancy,and the subsequent computed tomography scan indicated stable disease as well as significantly decreased pericardial and pleural effusions.The patient remains free of progression to date.CONCLUSION PBT was a safe and effective method of reirradiation for locoregionally recurrent breast cancer in our patient.

Reconstruction of complex chest wall defects:A case report

BACKGROUND Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy.If not treated early,then symptoms such as erosion,bleeding and infection will appear on the skin.In severe cases,ulcers invade the ribs and pleura,presenting a mortality risk.Small ulcers can be repaired with pedicle flaps.Because radioactive ulcers often invade the thorax,surgeons need to remove large areas of skin and muscle,and sometimes ribs.Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARY A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer.The patient was diagnosed with chronic radioactive ulceration.After multidisciplinary discussion,the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator(DIEP)flap combined with a high-density polyethylene(HDPE)patch.The patient was followed-up 6 mo after the operation.No pigmentation or edema was found in the flap.CONCLUSION DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

Necrotizing Soft Tissue Infections of the Male and Female Breast: A Literature Review

Background: Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The objective was to determine and summarize the frequency and characteristics of breast NF and NSTI in the literature. Methods: Cases were obtained through PubMed, Google Scholar, Google, and from published article reference sections. One hundred twenty-three cases were gleaned from 96 articles that reported NF and NSTI of the breast (1924 through 2021). Results: NF was reported in 70 and NSTI in 53 cases (111 women and 12 men). Patients presented with swollen, painful breasts, erythema, bullae, crepitus, necrosis, gangrene, fever, tachycardia, and neutrophilia. Fifty-nine of 123 (48.4%) patients were septic on admission. The most frequent microorganisms were β hemolytic Group A Streptococcus, and Staphylococcus aureus. Treatment consisted of antibiotics, mastectomy and debridement with flaps, skin grafts or primary and secondary closure. Forty-four (63.0%) of the NF cases had chest wall involvement;of these, 18 (14.6%) involved the breast secondarily, P < 0.0001. There were twelve mortalities (9.8%): eleven (9.0%) with NF and one (0.8%) with NSTI, P = 0.007. Conclusions: Men and women with breast NF and NSTI presented with similar signs and symptoms and required the same emergent treatment as provided for NF and NSTI of the more common sites. As a time-sensitive disease, patients treated within 12 hours of admission had a better survival. Patients with NF were more likely to have sepsis on admission, a higher mortality, and fascial chest wall/muscle involvement than patients with NSTI.

胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛作用研究

目的研究胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛作用。方法选取我院拟行单侧乳腺癌保乳根治术联合腋窝淋巴结清扫术的患者128例,按照随机信封法将患者分为4组。4组患者均实施全身麻醉,A组患者予以静脉自控镇痛(PCIA),B组患者予以胸壁神经阻滞,C组患者予以肋间神经阻滞,D组患者予以胸壁联合肋间神经阻滞。比较4组患者一般资料;评估术后4 h、12 h、24 h、48 h和72 h的视觉模拟量表(VAS)评分;比较4组患者麻醉前和术后72 h疼痛介质水平[血清神经肽Y(NPY)、P物质(SP)和β-内啡肽(β-EP)]以及不良反应发生率。结果4组患者一般资料比较差异均无统计学意义(P>0.05)。VAS评分经重复测量方差分析差异均有统计学意义(P<0.05);各组术后12 h、24 h的VAS评分均高于术后4 h,术后72 h的VAS评分均低于术后4 h,术后48 h、72 h的VAS评分均低于术后12 h、24 h,术后72 h的VAS评分均低于术后48 h,且D组术后4 h、12 h、24 h、48 h、72 h的VAS评分均低于其他组,A组术后48 h、72 h的VAS评分均低于B组、C组,差异均有统计学意义(P<0.05)。4组患者术后72 h血清NPY、SP和β-EP水平均高于麻醉前(P<0.05),且组间比较,4组患者麻醉前疼痛介质水平均无统计学差异(P>0.05),术后72 h D组NPY、SP和β-EP水平均低于其余3组(P<0.05);A组术后72 h疼痛介质水平均低于B组、C组(P<0.05),B组和C组术后72 h疼痛介质水平差异均无统计学意义(P>0.05)。4组患者均无神经阻滞相关并发症,不良反应发生率比较差异无统计学意义(P>0.05)。结论胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛效果较PCIA、单纯胸壁神经阻滞或肋间神经阻滞更好,可更有效地控制疼痛介质水平升高,且安全性良好。

手指爬墙肩梯在乳腺癌术后功能锻炼中的应用研究

目的 研究手指爬墙肩梯在乳腺癌术后功能锻炼中的应用效果。方法 将60例纳入研究的患者随机分成2组,对照组30例采用常规护理模式对乳腺癌术后患者进行干预,观察组30例在常规护理基础上采用手指爬墙肩梯来帮助患者做术后功能锻炼,比较乳腺癌患者术后功能锻炼的效果。结果 采用手指爬墙肩梯的乳腺癌术后患者,在术后功能锻炼上依从性及效果方面均优于常规护理模式组。结论 手指爬墙肩梯能够有效提高乳腺癌患者术后功能锻炼的依从性和效果。

乳腺癌改良根治术后胸壁复发结节的超声图像特征及预测模型构建

目的总结乳腺癌改良根治术后胸壁复发结节的超声图像特征,并构建预测模型,探讨其应用价值。方法选取我院102例乳腺癌改良根治术后胸壁结节患者,其中恶性结节57例(复发组),良性结节45例(良性组),比较两组超声图像特征;应用多因素Logistic回归分析筛选乳腺癌术后胸壁结节恶性风险预测因素,并建立预测模型,分析其预测胸壁结节恶性风险的诊断效能。结果两组结节最大径、数目、累及组织层次、边界、形态、钙化、周围组织回声变化、血流分级和间隔时间比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,胸壁结节最大径、数目、边界、血流分级、间隔时间是乳腺癌术后胸壁结节恶性风险的独立影响因素(均P<0.05)。建立预测模型为:Logit(P)=-5.126+0.086X1+2.315X2+2.549X3+1.874X4+1.945X5(X1:病灶最大径,X2:病灶数目,X3:边界,X4:血流分级,X5:间隔时间),其预测胸壁结节恶性风险的灵敏度、特异度、准确率、曲线下面积及95%可信区间分别为91.2%、82.2%、87.3%、0.935(0.890~0.979)。结论基于超声图像特征构建的预测模型能有效评估乳腺癌改良根治术后胸壁结节恶性风险。

胸壁神经+胸横肌平面阻滞在乳腺癌的应用

目的通过观察胸壁神经阻滞联合胸横肌平面阻滞在乳腺癌改良根治术后镇痛中的应用效果,为临床乳腺癌患者手术后镇痛方案的合理应用奠定基础并提供实验依据。方法筛选纳入被诊断为乳腺癌,并在2021年01月-2022年01月期间进行乳腺癌改良根治术的82例女性患者,通过随机化分组(分组方法为随机数字表法),对照组的41例患者在全麻诱导前进行胸壁神经阻滞,观察组的41例患者在全麻诱导前进行胸壁神经阻滞联合胸横肌平面阻滞,确认阻滞成功后实施麻醉诱导、麻醉维持,开展乳腺癌改良根治手术。观察患者术后6 h、12 h和术后24 h的疼痛评分,统计患者术后PCIA有效按压次数、补救镇痛情况,记录患者神经阻滞操作相关并发症的发生情况。结果与对照组术后6 h、12 h和24 h手术部位的疼痛评分相比,观察组要更低,且术后PCIA有效按压次数及补救镇痛情况更少,经t检验得出差异存在统计学意义(P<0.05)。两组均未发生神经阻滞操作相关并发症,包括穿刺部位血肿、气胸、血胸等。结论与单纯的胸壁神经阻滞相比,胸壁神经阻滞联合胸横肌平面阻滞在行乳腺癌改良根治术中的应用,能够获得更好的术后镇痛效果,并可降低术后阿片类药物的用量,具有良好的安全性,是一种可在临床广泛应用的镇痛方法。

光面爆破技术探讨与实践

光面爆破技术是控制隧道超欠挖的一项重要举措,本文结合光面爆破技术并改善导爆索网路搭接方式,修正周边孔与内圈孔间的起爆时差,以旗杆山隧道为背景开展现场试验。结果表明:“T”搭接方式增加了起爆网路的可靠性;起爆时差由200ms控制在50ms~110ms之间;爆后轮廓面上孔痕率达到90%以上;平均每循环降低混凝土超耗4.57m3,有效地控制了超欠挖。此技术推广应用于城开高速公路各在建隧道施工中,可为类似工程提供参考。

带消浪孔沉箱上部胸墙裂缝控制

随着社会的发展,科学的进步,在水工行业中,沉箱码头的沉箱形式愈发多样。本文以一个有消浪孔沉箱的重力式码头为例,阐述带消浪孔沉箱胸墙易产生裂缝的原因及控制措施,为裂缝控制的相关施工提供借鉴经验与依据。

超声引导下胸壁神经阻滞联合全身麻醉在乳腺癌手术患者中的应用

目的:探讨超声引导下胸壁神经阻滞联合全身麻醉在乳腺癌手术患者中的应用.方法:选取2019年7月至2021年6月在本院接受手术治疗的100例乳腺癌患者,按随机数字表法将其分为研究组(n=50)和对照组(n=50).研究组采用超声引导下胸壁神经阻滞联合全身麻醉,对照组采用全身麻醉.观察两组术中入室时(T_(0))、插管时(T_(1))、切皮时(T_(2))、拔管时(T_(3))血流动力学指标变化;比较两组术后1h、4h、8h、12h、24h疼痛程度.结果:两组T_(1)、T_(2)时收缩压、舒张压及心率均低于T_(0)时水平,但研究组高于对照组(P<0.05);与T_(2)时比较,两组T_(3)时收缩压、舒张压及心率均上升,而研究组低于对照组(P<0.05).两组术后4h、8h时视觉模拟评分法(VAS)评分较术后1h升高,而在术后12h、24h时VAS评分较术后8h降低,而研究组在各时点VAS评分均低于对照组,差异有统计学意义(P<0.05).结论:超声引导下胸壁神经阻滞联合全身麻醉应用于乳腺癌手术中可维持患者血流动力学稳定,减轻术后疼痛.