Outcomes of breast reconstruction with pedicled transverse rectus abdominis myocutaneous [TRAM] flap at cancer institute: a retrospective study of 10 years of experience

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

[Use of the omentum flap for reconstruction of large chest wall defects]

Use of alloplastic material such as Gore-Tex and loco regional flaps for reconstruction of the large defects of chest wall has been well described. The purpose of this article is to present a useful technique of using the pediculated omental flap to cover the large chest wall defects. Three patients with large thoracic wall defects underwent reconstruction with omental flap with or without prolene mesh. These defects resulted from tumor resection. Their dimensions ranged from 25x30cm to 35x50cm. The omentum was tunneled through a separate opening in the abdominal wall into the subcutaneous plane and used to cover the defect and inner surface of prolene mesh. There was no complication and all wounds healed with no recurrence. The patients were followed for two years and there was no tumor recurrence or wound breakdown. Omental flap is a reasonable alternative for chest wall reconstruction especially when delay wound healing anticipated or when others loco regional flap are not appropriate

Application of small angle X-ray scattering [SAXS] for differentiation between normal and cancerous breast tissues

Small angle X-ray scattering [to angles less than 10[degree sign]] is predominantly coherent. Coherent scattering leads to diffraction effects and especially constructive interferences. These interferences carry some information about the molecular structure of the tissue. As breast cancer is the most widespread cancer in women, this project evaluated the application of small angle X-ray scattering [SAXS] for differentiation between normal and cancerous breast tissues. The energy dispersive method with a set up including X-ray tube, primary collimator, sample holder, secondary collimator and HP Ge detector was used. The best constructive interference was found to be at 6.5[degree sign] after doing experiments on adipose breast tissue at several angles of 4, 5, 6, 6.5 and 7.3 degrees. The total number of 99 breast tissue samples, including normal and tumor were studied at the 6.5[degree sign]. The corrected intensity versus momentum transfer was obtained for each sample. Adipose tissue shows a sharp peak in low momentum transfer region. It is easy to separate adipose tissue and mixed tissue [adipose and fibroglandular] from tumor in peak positions [each coherent scattering spectrum has a peak that its position is determined by momentum transfer]. Furthermore adipose tissue has shown significantly higher peaks than other breast tissues. Benign and malignant breast tissues were differentiated by both peak positions and peak heights [each peak has a height in coherent scattering spectrum]. Preservation of samples nitrogen tank had no effects on molecular structure of the breast tissue. By energy dispersive small angle X-ray scattering, it is possible to differentiate between normal, benign and malignant breast tissues