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Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.
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Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.
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Objective:To explore the occurrence of symptoms in postoperative patients with oral cancer, and to explore the types and number of symptom groups.Methods:The Anderson symptom assessment scale for head and neck cancer was used to conduct a questionnaire survey on 345 patients after oral cancer surgery. The results of two exploratory factor analysis methods were compared, and the cluster analysis and Spearman rank correlation analysis were combined to determine the symptom group of patients after oral cancer surgery.Results:There were 4 symptom groups in patients with oral cancer, including oral and pharynx symptoms group, dietary and digestive symptoms group, gastrointestinal and emotional symptoms group, and rest activity symptoms group.Conclusions:There are many symptom groups that affect the life of patients with oral cancer in the rehabilitation process after surgery, so the medical staff should carry out targeted intervention mode to achieve better intervention effect.
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Objective:To introduce the advantages and clinical experience of relaying antero thigh flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer for oral cancer defect reconstruction.Methods:The number, courses and location of antero thigh perforators were recorded in 6 adult specimens, (3 male and 3 female). Specimen was produced via femoral artery perfusion after joining lead oxide red setting, up to the inguinal ligament, down to the superior margin of patella, lateral to the lateral femoral intermuscular septum, medial near the lateral margin of adductor longus muscle. From February 2016 to December 2018 in Hunan Provincial Cancer Hospital, 13 cases (11 male and 2 female) with oral carcinoma (8 tongue carcinoma and 5 buccal cancer), leaving tongue or mouth defects which were reconstructed by free AMT perforator flaps.Results:All free AMT flaps were harvested smoothly, the flap size ranged from 7.5 cm×4.5 cm to 13.0 cm×7.5 cm, the donor sites were reconstructed with relaying ALT flaps in 10 cases, with relaying AMT flaps in 3 cases, the relaying ALT flap size ranged from 8.5 cm×5.0 cm to 18.0 cm×7.0 cm, the relaying AMT flap size ranged from 7.5 cm×4.0 cm to 15.0 cm×7.0 cm. All flaps survived uneventfully, no vascular crisis or wound dehiscence, infection occurred. All patients were followed up for 12~28 months, all flaps healed smoothly, only linear scar was left in the donor sites, the color, appearance and contour of flaps were natural, and the function of thighs were not affected.Conclusions:When it is difficult to elevate the free anterolateral thigh flap, the free anteromedial thigh flap can be used to repair the oral cancer defect. When the direct closure of the flap donor area is of big tension, the relaying antero flap can be used to reconstruct the donor site, minimize the operation time and improve the outcome.
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Objective:To explore the clinical application of conjoined bipedicle deep inferior epigastric perforator flap (DIEP) in reconstruction of unilateral breast for patients with breast cancer.Methods:From August, 2007 to Feburary, 2017, 41 cases of breast cancer patients received conjoined bipedicle DIEP to reconstruct breasts at the same time of radial operation of mastocarcinoma or in the second phase. Their age ranged from 27 to 49 (34.5±2.7) years old. Twenty-two cases had one-staged and other 19 had two-staged breast reconstruction. All patients were in scheduled followed-up.Results:In this study, 41 conjoined bipedicle DIEP were harvested, including 12 of lateral branch type, 9 of medial branch type, and 20 of combined lateral and medial branch type. The length of flap was (24.5±0.5) cm, the width of flap was (10.8±2.8) cm, and the thickness of flap was(5.5±0.4) cm. The length of flap pedicle was (12.5±0.6) cm. The average weight of flap was 565 (ranged 365-1 050) g. The vascular combinations in the receiving area included: ①Eighteen cases of proximal and distal thoracic vessels. ②Eleven cases proximal ends of internal mammary vessels and lateral thoracic vessels. ③Eight cases of proximal ends of internal mammary vessels and thoracodorsal vessels. ④Four cases thoracodorsal vessels and lateral thoracic vessels. In 3 patients, in order to further promote the venous outflow of the flap, the superficial inferior epigastric vein of the flap was anastomosed with the thoracoacromial vein of the recipient area. All flaps were successful and completely survived without marginal necrosis or infection. The shape, texture and elasticity of the reconstructed breasts were good without flap contractive deformity. There were only linear scars left in the donor sites, and function of abdomen was not affected. All 41 patients were followed-up for 12 to 50 months, with an average of 15.8 months with satisfied results. No local recurrence happened. Only linear scar was left in the donor site of abdomen, and the function of abdominal wall was not affected. In all cases bilateral rectus abdominis muscle strength was level 5.Conclusion:The conjoined bipedicle DIEP could be a safe and valuable option as an alternative method for autologous breast reconstruction.
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Objective@#To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction.@*Methods@#From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded.@*Results@#(1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications.@*Conclusions@#Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.
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Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.
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Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.
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Objective@#To explore the clinical application of the deep inferior epigastric artery perforator flap in bilateral breast reconstruction of patients with breast cancer.@*Methods@#Deep inferior epigastric artery perforator flap was applied for breast reconstruction in four cases of breast cancer patients received radical or modified radical surgery in Hunan Provincial Cancer Hospital. All patients are female, age ranged from 31 to 53 years old (36.2±5.9).@*Results@#The length of flap was (15.1±0.4) cm, the width of flap was (12.6±0.3) cm, the thickness of flap was (4.3±0.5) cm. The length of pedicle was (12.6±0.3) cm, the outer diameter of artery was (1.8±0.2) mm, the outer diameter of vein was (2.1±0.4) mm.The average weight of flaps was 235 g(ranged from 195 g to 335 g). In one case flap fat necrosis occurred and in other one donor site fat necrosis was noted. The two flaps both healed with dressing treatment and no other complications were found. The reconstructed breasts′shape, texture and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of abdomen did not affected. All 4 patients were followed up for 14 to 33 months (21.7 months on average) with satisfied result. No local recurrence happened.@*Conclusions@#Free deep inferior epigastric artery perforator flap is suitable to reconstruct bilateral breast for breast cancer patients.
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Objective@#To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice.@*Methods@#Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized.@*Results@#Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury.@*Conclusion@#The modified TOETVA by dissection of mental nerve is safe and feasible.
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Objective@#To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction.@*Methods@#From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types.@*Results@#All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease.@*Conclusions@#The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed.
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Objective@#The purpose of this study is to review the single institutional experience in oncoplastic treatment of locally advanced breast cancer (LABC).@*Methods@#This is a retrospective analysis of 246 female patients who underwent breast and chest wall reconstruction after LABC ablation in the department from August 2007 to December 2015. The mean age of the patients is 43.7 years old, range from 34 to 70 years old. The soft tissue defect size ranged from 12 cm×6 cm to 32 cm×28 cm, different flaps were chosen for reconstruction, flap size ranged from 13 cm×6 cm to 33 cm×29 cm. Simple rib defects or sternum defects occurred in 65 cases, using mesh repair and flap reconstruction; simple soft tissue defects were noted in 112 cases, pedicled flap or free flap was used; in 69 cases complicated composite chest wall defects involving multiple layers (soft tissue, ribs/sternum, and intrathoracic organs) were repaired with methylmethacrylate/polypropylene mesh sandwich prostheses. The breast and chest wall soft tissue defects were repaired with pedicled or free flap.@*Results@#In 3 cases with pedicled rectus abdominis flap partial necrosis was noted, local flap was used after further debridement in 2 cases, in the third case with extensive defect left, free anterolateral thigh flap was transferred for reconstruction. In 2 cases with free deep inferior epigastric artery perforator flap, postoperative venous congestion occurred. The re-exploration procedure was carried out, edema was removed and the flap survived thoroughly. In 2 cases with free deep inferior epigastric artery perforator flap postoperative course margin dehiscence and chest wall basement partial necrosis was noted, free anterolateral thigh flap was transferred for reconstruction after thoroughly debridement, the wounds healed smoothly. All other wounds healed uneventfully, all flaps survived totally. The hospital stay time ranged from 12 days to 42 days, all patients received further therapy. The mean follow-up was 28.8±0.4 months, with a range from 9 to 96 months. 26 cases were lost for follow up, in the rest 220 cases, local tumor recurrence was noted in 52 cases, distant metastasis was noted in 42 cases, all other patients recovered well, the function and appearance of flaps were satisfactory, the life quality of patients improved notably.@*Conclusions@#Oncoplastic techniques are suitable and safe for LABC reconstruction, helpful for oncological local control, can improve patients life quality.
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Objective@#To evaluate the efficacy of modified bilobed chimeric thoracoacromial artery perforator (TAAP) flap for the reconstruction of hypopharyngeal defect with anterior neck skin loss.@*Methods@#Between May 2013 and September 2015, modified bilobed chimeric TAAP flap was used to reconstruct complex oncologic hypopharyngeal defects in 7 patients, including 6 males and 1 female. Patients′ age ranged from 28 to 65 years old (mean age 50±3.4 years old). The size of hypopharyngeal defect ranged from 5.5 cm×3.5 cm to 12.0 cm×4.5 cm, and the size of anterior neck defect ranged from 8.0 cm×4.0 cm to 10.0 cm×4.0 cm.@*Results@#The size of TAAP flap was from 6.5 cm×4.0 cm to 13.0 cm×5.0 cm.The size of pectoralis major flap was from 8.0 cm×4.5 cm to 11.0 cm×5.0 cm. The length of pedicle was 6.5-8.5 cm.The distance from pivot point of flap to central point of recipient site was 7.0-9.5 cm.All flaps survived thoroughly, the donor site was closed directly in all cases.The mean hospital stay ranged from 14 to 19 days (mean 15.5 days). The follow-up was 14, 15, 20, 18, 30, 25 and 38 months respectively.Patient possessed good appearance of neck surgical sites, and oral diet was restored in all patients.No recurrence, fistula, stenosis/stricture, dehiscence, or swelling occurred, only with scars left on the donor sites, and pectoralis major muscle function was completely preserved in all patients.@*Conclusions@#Modified bilobed chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defect with anterior neck skin loss.
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Objective To review outcome and experience in application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment.Methods From January 2008 to February 2016,61 cases (included 58 female patients and 3 male patients) were admitted,the age ranged from 39 to 57 years old.Among these cases,37 cases received mastectomy and one-staged breast reconstructive operation and multiple chemotherapy preoperatively.The other 24 patients suffered from chest wall radiation ulcer,all occurred after mastectomy and radiotherapy,the course ranged from 12 to 56 months,all received long-time conservative therapy but the patient's condition worsened.Of those patients 8 cases suffered radioactive bone injury,involved clavicle,rib and sterum;3 cases suffered pleura injury;2 cases suffered lung injury;2 cases suffered brachial plexus injury and upper extremity lymphedema,resulted in upper extremity dysfunction.The patients were treated with pure pedicled transverse rectus abdominis musculocutaneous flap (TRAM) musculocutaneous flap in 31 cases,frec TRAM musculocutaneous flap in 3 cases,pedicled TRAM musculocutaneous flap plus superficial inferior epigastric vein anastomosis in 13 cases,and pedicled TRAM musculocutaneous flap combined with contralateral free deep inferior epigastric perforator (DIEP) flap in 14 cases.Results The area of flap for chest wall reconstruction ranged from 22 cm × 10 cm to 38 cm× 15 cm,the size of flap for breast reconstruction ranged from 16 cm × 10 cm to 22 cm× 13 cm.The donor site was closed directly in all cases.Distal part necrosis and fat liquefaction were noted in 3 cases used pure pedicled TRAM musculocutaneous flap,in 1 case the defect was closed directly after radical debridement,in other 2 cases free anterolateral thigh flap was applied after debridement.All other 58 flaps survived uneventfully.All patients were followed up for 12 -108 months with satisfied esthetic and functional results in reconstructed chest wall and breast.No local recurrence or ulcer happened.Only linear scar left in the donor sites,no hernia occurred.Conclusions Transverse rectus abdominis musculocutaneous flap is one of the first choice for breast reconstruction and chest wall radioactive ulcer.To ensure the operation success,it is efficient to apply different forms of transverse rectus abdominis musculocutaneous flap according to the flap size and blood supply.
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Objective To describe the relationship status of breast reconstruction after mammary gland surgery, and to explore the changes of sexual and emotional experience in breast reconstruction. Methods A semi-structured in-depth interview was conducted in 19 patients admitted to Hunan Cancer Hospital from October 2015 to December 2017 for reexamination in the hospital from 2 to 26 months after breast reconstruction. The Giorigi method was used to analyze data in the phenomenological analysis of qualitative research. Data collection, transfer and analysis are conducted simultaneously, and the method and content of the next interview were constantly adjusted with the existing data analysis results. Results The sex and emotional experience of breast reconstruction after breast surgery could be summarized into 5 subjects. The first was cognition of sexual life . The second was sexual psychological change.The third was physiological changes. The forth was the desire for sexual information. The fifth was breast reconstruction surgery brings the emotional fluctuation of both husband and wife. Conclusions Understanding of breast cancer postoperative breast reformer sexual and emotional experience can help medical personnel through effective communication and evaluation, provide targeted health education and consultation, improve recovery quality of life of patients.
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Objective To evaluate the effect of education on the family function of breast reconstruction after breast cancer. Methods Totally 130 cases of breast reconstruction after breast cancer were selected from January 2015 to August 2017, and 65 cases were divided into observation group and control group by random number table method. The control group received routine education; The observation group and the spouse received synchronous education. In the preoperative and postoperative 3 months, 6 months after the Female Sexual Function Index (FSFI) to assess patients sexual function, the Family Intimacy and Adaptability Scale to assess the patient's family intimacy and adaptability, comparing the indicators of two groups of patients. Results After 6 months of operation, the two groups were compared, and the intervention group was (24.82 ± 3.75) points, and the control group was (22.32±4.75), with statistically significant difference(t=- 3.35, P < 0.05). Comparison of familial closeness and adaptability score of the two groups, the intervention group was (76.80 ± 8.14) points, (59.98 ± 3.56) points; The control group was (68.48 ± 11.46) points, (52.27 ± 9.49) points,with statistically significant difference(t=-4.81,-6.18, P<0.05). Conclusion The simultaneous education can improve the sexual function and familial intimacy and adaptability of breast reconstruction after breast cancer.
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Objective To explore the nursing effect of discharge preparation service on breast reconstruction after breast cancer operation. Methods Totally142 patients with breast cancer were divided into intervention group and control group according to the random number table, 71 cases in each group.The intervention group carried out discharge plan mode,the control group did not carry out discharge plan mode, only routine nursing and telephone follow-up after discharge.To compare the differences of discharge readiness, self-efficacy,quality of life and patient satisfaction score of family caregivers at 2 days after admission,when discharge,2 months,3 months and 6 months after discharge.Results The score of discharge readiness of family caregivers in intervention group,score of self-efficacy,quality of life score and patient satisfaction score of nursing were 29.76 ± 1.06, 35.72 ± 2.06, 69.20 ± 2.76, 30.79 ± 2.23, the control group were 24.85 ± 2.94, 35.72 ± 2.81, 64.55 ± 4.75, 26.99 ± 3.27, the difference between the two groups was statistically significant (t=-13.25--7.13, P<0.05). Conclusions Discharge preparation service can improve the discharge readiness of family caregivers of breast cancer patients after breast cancer reconstruction, their self-efficacy after discharge, their quality of life and nursing satisfaction, so it is worthy of promotion.
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Objective To introduce the clinical experience of relaying anterolateral thigh (ALT)flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer.Methods From February 2014 to December 2015,16 cases with oral carcinoma underwent radical resection,leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps.The flap size ranged from 7.5 cm ×4.5 cm to 13.0 cm × 7.5 cm [the patients was 45.6 years (range 31-72 years),body mass index (BMI) range 17.5-24.3 kg/m2].Flaps'width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5％ on average (ranging from 9.8％ to 15.7％).The flap donor sites were reconstructed with relaying ALT flap at the same stage,the flap size ranged from 7.5 cm × 4.0 cm to 12.0 cm x 7.0 cm.Results The AMT and ALT perforators existed consistently in all cases of this serie.All free AMT flaps and relaying ALT flaps survived uneventfully.All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites.2-point discrimination distance of AMT flaps ranged from 7 to 14 mm,2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm,the function of thighs were not affected.Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap.
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Objective To observe the outcome of free TAAP flap in the reconstruction of defect after oral tumor radical resection.Methods From June,2010 to April,2015,12 patients with oral tumor underwent radical resection,including 4 cases of gingival carcinoma,3 cases of tongue carcinoma and 5 case of buccal cancer.The cause ranged from 2 to 12 months.The radical resection left defects with size ranged from 4.5 cm×3.5 cm to 6.0 cm× 4.5 cm which were reconstructed by free TAAP flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm.The length of TAAP flap was (6.5±0.6) cm.The width of flap was (4.3±0.5) cm.And the thickness of flap was (1.1±0.3)cm.The length of pedicle was(8.4±0.2) cm.All the arteries of TAAP were anastomosed with superior thyroid arteries,while the venae comitans were anastomosed with superior thyroid venae or internal jugular venae.Results The perforators existed consistently.All 12 flaps survived uneventfully.The donor sites were closed directly in all cases.All patients were followed up for 14-38 months with satisfied esthetic and functional results in reconstructed tongue.No local recurrence happened.The shoulder function was not affected.Conclusion The TAAP flap has consistent blood supply,good color match and texture,while leaving minimal morbidity at donor site,is an ideal choice for buccal tumor reconstruction.
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Objective@#To explore investigate the application of free medial thigh perforator flaps with different pedicle origins in the reconstruction of defect after radical resection of buccal mucosa squamous cell carcinoma.@*Methods@#From January 2015 to December 2016, 32 cases with buccal mucosa squamous cell carcinoma underwent radical resection and buccal mucosa defect after surgery was reconstructed by free medial thigh perforator flap at the same stage. The patients included 32 males and 5 females, ranged in age from 36 to 71 years (45.2 years on average). According to UICC stage: T4N0M0 13 cases, T4N1M0 12 cases, T3N1M0 5 cases, T3N2M0 2 cases. The course ranged from 1 to 30 months (9.6 months on average).@*Results@#The perforator flaps ranged from 8.0 cm×3.5 cm to 15.5 cm×6.0 cm in size, from 2.0 to 4.5 cm in thickness.The mean length of pedicles from gracilis muscle was (8.7±0.4) cm in 19 cases, the mean length of pedicles from adductor magnus muscle was (9.5±0.4) cm in 9 cases and the length of pedicles from femoral artery was (6.9±0.5) cm in 4 cases.All 44 perforator flaps survived uneventfully. The donor sites in the medial thigh were closed directly and healed well in all cases. Patients were followed up for 8 to 32 months with satisfied esthetic and functional results in reconstructed tongue, with no local recurrence. Only linear scars left in the donor sites, the functions of thighs were not affected.@*Conclusion@#The free medial thigh perforator flap is an idea choice to reconstruct the defect after radical resection of buccal mucosa squamous cell carcinoma.