ABSTRACT
Sentinel node biopsy [SLNB] is the standard of care for breast cancer treatment and it is getting wide acceptance in Iran. The radiation safety of the procedure has been investigated under controlled conditions, but the standard dose of radiotracer and techniques are not always observed in the community setting. The aim of this study was to assess the magnitude of the absorbed doses of radiation to the hands of operating surgeons. Twenty consecutive SLNB procedures were studied. Radiation dose to the hands of the surgeons was measured by placing lithium fluoride thermoluminescent dosimeters [TLDs] in the surgeons' glove. The radiation dose to the abdomen and thyroid area was measured by placing TLDs at these areas. The injected dose of radiotracer, the time interval to the surgery and the duration of the surgery were recorded. The injected dose of radiotracer ranged from 0.1 to 5 mCi. The highest absorbed dose was recorded by TLD, placed on the non-dominant hand third finger [189.1 microSv]. Mean recorded doses were higher for non-dominant hand second finger [53.49 +/- 24.60 microSv]. The measured absorbed doses for the abdominal and thyroid area were lower than those for the fingers. This study has confirmed the procedure safety, even with high dose of radiotracer. Nevertheless, it is advisable to use the lowest dose of the radiotracer to avoid the waste of resources
ABSTRACT
Reconstruction of breast with transverse rectus abdominis myocutaneous [TRAM] flap is the standard for reconstruction of breast following mastectomy. In this article, authors report their experience with pedicled TRAM flap reconstruction of the breast. Records for the patients who had undergone breast reconstruction with pedicled TRAM flap were retrieved. Records of outpatient followups were also obtained. Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from zero [not satisfied] to ten [most satisfied]. There were 61 reconstructions in 59 patients. In 42 [71.2%] cases a synthetic mesh and in 14 [23.7%] cases dermal graft was used for closure of the abdominal fascial defect. The mean hospital stay was 10.67 [1 - 72] days. Patients were followed up for a mean period of 621 days. The overall rates of complications were as follows: partial flap necrosis: 11 [18.6%], flap hematoma: 2 [3.4%], flap seroma: 7 [11.9%], flap wound infection: 7 [11.9%], abdominal wound hematoma: 9 [15.3%], abdominal wound seroma: 5 [8.5%], abdominal wound ischemia: 1 [1.7%], abdominal wound incisional hernia: 6 [10.2%], deep vein thrombosis: 1 [1.7%], complication requiring rehospitalization: 9 [15.3%], complication requiring reoperation: 8 [13.6%]. There were no abdominal wound infection, no umbilical necrosis, and no pulmonary embolism. Aesthetic results were classified as excellent [62%], good [28%], fair [10%]. The mean satisfaction score was 9.5 [range 6-10]. Breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap was associated with a low complication rate and a high level of patient satisfaction in our center