There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer...There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.展开更多
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-select...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 1<sup>st</sup> January 2018 to 30<sup>th</sup> 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/m<sup>2</sup>. 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.展开更多
Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on ...Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960 s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast recon-struction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.展开更多
目的探讨背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建在乳腺癌术后的应用价值。方法回顾性分析2014年1月至2019年1月于深圳市中医院行乳腺癌改良根治术治疗的86例乳腺癌患者的临床资料,根据乳房重建方式的不同将其分为假体组(40例)和自...目的探讨背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建在乳腺癌术后的应用价值。方法回顾性分析2014年1月至2019年1月于深圳市中医院行乳腺癌改良根治术治疗的86例乳腺癌患者的临床资料,根据乳房重建方式的不同将其分为假体组(40例)和自体脂肪组(46例)。两组患者均行常规乳腺癌改良根治术,假体组患者在术后行背阔肌肌皮瓣联合假体置入即刻乳房重建,自体脂肪组患者在术后行背阔肌肌皮瓣联合自体脂肪组织置入即刻乳房重建。比较两组患者术后临床情况、癌症自我管理效能感量表(strategies used by people to promote health,SUPPH)、生活质量核心量表(quality of life questionnaire-core 30,QLQ-30)、生活质量满意度、美观效果和并发症发生情况。结果两组患者术后引流时间、住院天数、开始辅助治疗时间比较差异均无统计学意义(均P>0.05)。两组患者术后SUPPH、QLQ-30评分均显著高于本组术前(均P<0.05),自体脂肪组患者术后SUPPH、QLQ-30评分均显著高于假体组(均P<0.05)。自体脂肪组患者术后焦虑占比和术后总并发症发生率均显著低于假体组(均P<0.05),对体型、社交满意的占比和美学效果优良率均显著高于假体组(均P<0.05)。结论乳腺癌改良根治术后行背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建安全性较高,美观效果较好,可显著提高患者生活质量。展开更多
文摘There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.
文摘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 1<sup>st</sup> January 2018 to 30<sup>th</sup> 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/m<sup>2</sup>. 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.
文摘Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960 s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast recon-struction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.
文摘目的探讨背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建在乳腺癌术后的应用价值。方法回顾性分析2014年1月至2019年1月于深圳市中医院行乳腺癌改良根治术治疗的86例乳腺癌患者的临床资料,根据乳房重建方式的不同将其分为假体组(40例)和自体脂肪组(46例)。两组患者均行常规乳腺癌改良根治术,假体组患者在术后行背阔肌肌皮瓣联合假体置入即刻乳房重建,自体脂肪组患者在术后行背阔肌肌皮瓣联合自体脂肪组织置入即刻乳房重建。比较两组患者术后临床情况、癌症自我管理效能感量表(strategies used by people to promote health,SUPPH)、生活质量核心量表(quality of life questionnaire-core 30,QLQ-30)、生活质量满意度、美观效果和并发症发生情况。结果两组患者术后引流时间、住院天数、开始辅助治疗时间比较差异均无统计学意义(均P>0.05)。两组患者术后SUPPH、QLQ-30评分均显著高于本组术前(均P<0.05),自体脂肪组患者术后SUPPH、QLQ-30评分均显著高于假体组(均P<0.05)。自体脂肪组患者术后焦虑占比和术后总并发症发生率均显著低于假体组(均P<0.05),对体型、社交满意的占比和美学效果优良率均显著高于假体组(均P<0.05)。结论乳腺癌改良根治术后行背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建安全性较高,美观效果较好,可显著提高患者生活质量。
