Skin-sparing Mastectomy and Immediate Nipple Graft for Large, Ptotic Breast / 한국유방암학회지

Volumetric changes of the pedicled transverse rectus abdominis musculocutaneous flap and the contralateral native breast during long-term follow-up

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.

Unilateral pedicled transverse rectus abdominis musculocutaneous flap and unilateral free deep inferior epigastric artery perforator flap as a surgical alternative in bilateral autologous breast reconstruction

BACKGROUND: Bilateral microsurgical autologous reconstruction is known to increase operating time, costs, and complications compared to unilateral procedures. This study aimed to determine whether a unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap and a unilateral deep inferior epigastric artery perforator (DIEP) free flap could be a feasible option for bilateral reconstruction in selected circumstances. METHODS: A retrospective chart review identified patients who underwent unilateral pedicled TRAM and unilateral DIEP reconstruction for bilateral breast reconstruction between 2011 and 2014. Surgical outcomes, complications, and aesthetic scale questionnaire responses were evaluated. RESULTS: Fourteen patients were included in this study. Ten patients received bilateral immediate reconstruction, while four patients with a previous history of mastectomy underwent unilateral immediate reconstruction and contralateral delayed reconstruction. All flaps survived without any major complications. A case of nipple-areolar skin necrosis on the pedicled TRAM side and a case of mild abdominal bulging at the free DIEP donor site were reported. There was no partial flap necrosis or palpable fat necrosis. On the aesthetic outcome scale, the free DIEP flaps scored significantly higher than did the pedicled TRAM flaps for overall shape, the upper medial and lower lateral quadrant, and the lateral chest wall. CONCLUSIONS: Our findings suggest that a unilateral pedicled TRAM flap together with a unilateral free DIEP flap could be performed as a bridging surgical option as institutions move toward bilateral free-flap reconstructions, as a way to reduce operating time and the risk of microsurgery-related complications with acceptable donor site morbidity and aesthetic outcomes.

Treatment of Metacarpal Bone Fracture Using Biodegradable Plates and Screws

PURPOSE: Metacarpal fractures are common hand injury that may require operative intervention to ensure adequate reduction and stabilization. Traditionally, titanium miniplate was used for rigid fixation of bone fractures. However, the use of permanent plate lends itself to multiple complications such as infection, exposure of the hardware, tendon adhesions, tendon rupture, prolonged pain, bony atrophy and osteoporosis (stress shielding), metal sensitization, and palpation under the skin. This study evaluated the usefulness and stability of biodegradable plates and screws for treatment of metacarpal bone fractures. METHODS: There was 17 patients who had surgery for metacarpal bone fracture from April 2007 to June 2010. All patients had open reduction and internal fixation. We used absorbable plates and screws (Inion CPS(R)) for internal fixation. Postoperative results were assessed with x-ray. Stability of plates and screws, healing process and its complications were observed by clinical and radiographic assessment. RESULTS: All patients were successfully reduced of bone fracture, and fixations with absorbable plates and screws were stable. The mean follow up period was 7.1 months. 2 patients complained postoperative pain, but they were relieved with analgesics. All patients experienced transient stiffness, but they were relieved with active assistive range of motion after removal of splint. No patients suffered complications which could be occurred by using metallic plate. CONCLUSION: There was no critical complications such as re-fracture or nonunion among patients. No patients suffered side effects related with metallic implants. Biodegradable implants can offer clinically stable and attractive alternative to metallic implants to stabilize metacarpal bone fractures in the hand.