Clinical application of transverse rectus abdominis musculocutaneous flap reserving partial anterior sheath (TRAM-RPAS) in the one-stage breast reconstruction for patients with breast cancer / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of TRAM-RPAS flap in the one-stage breast reconstruction for patients with breast cancer, and to discuss the method to reduce the incidence of abdominal hernia and abdominal bulging.</p><p><b>METHODS</b>From 2002 to 2004, 16 cases of breast cancer (9 cases in stage I or II and 7 in stage III) received radical resection and breast reconstruction with TRAM-RPAS flaps at the same stage.</p><p><b>RESULTS</b>Good symmetry was achieved in 12 cases. In the other 4 cases, 3 cases had moderate breast poptosis and one case had breast hypoplasia on the unaffected side. All the flaps survived with only one case of abdominal bulging.</p><p><b>CONCLUSIONS</b>TRAM-RPAS flap can achieve the same result as traditional TRAM-RPAS flap in the one-stage breast reconstruction, while the incidence of abdominal complication is lower for TRAM-RPAS flap.</p>

Stereotactic core needle biopsy for diagnosis of mammographic minimal lesions / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the value of X-ray stereotactic core needle biopsy (SCNB) in diagnosis of mammographic minimal lesions.</p><p><b>METHODS</b>Thirty-one cases with suspicious malignant lesions detected by mammography underwent breast biopsy using computer-assisted stereotactic system with spring-loaded biopsy guns and 16G core needles. All specimens underwent histopathologic examination. Surgical operations were performed in 24 cases after SCNB, and pathological findings of SCNB specimens were compared with those of surgical biopsy.</p><p><b>RESULT</b>Among 24 cases with surgical excision, 8 cases (33.3%) were confirmed as breast carcinoma, and the other 16 cases (66.7%) was benign breast lesions. The consistency rate of diagnosis with two methods was 87.5%.</p><p><b>CONCLUSION</b>As a safe and effective diagnostic method, SCNB is preferred approach to differentiate between malignant and benign diseases of minimal breast lesions before surgery.</p>

Deep inferior epigastric perforator (DIEP) free flap in immediate breast reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>In order to facilitate psychological rehabilitation of the women who underwent modified radical mastectomy for breast cancer, the DIEP free flap was used for immediate breast reconstruction in a series of patients. We present a review of the surgical outcomes.</p><p><b>METHODS</b>From December 2001 to January 2003, unilateral breast reconstruction was performed in 12 patients using the DIEP free flap at the same time of modified radical mastectomy in our department. The recipient vessels were the thoracodorsal artery and vein or the internal mammary artery and its venae concomitants.</p><p><b>RESULTS</b>Of the 12 DIEP flaps, 1 was vascularized by a single perforator, 3 were vascularized by two perforators, 6 by three perforators, 1 by four an 1 by five perforators. One flap failed totally, likely due to previous multiple lower abdominal operations. The eleven reconstructed breasts achieved almost the same size and shape as the healthy sides. The time of patient getting out of bed ranged from 3 to 7 days and the mean hospital stay was 8.8 days. All patients were satisfied with the outcome. No complications were observed in the abdominal wall, including weakness, abdominal bulge or hernia.</p><p><b>CONCLUSION</b>Immediate breast reconstruction facilitates the psychological rehabilitation and helps to avoid the dressing inconveniences resulted from total mastectomy. Free DIEP flap is a new and reliable technique for immediate breast reconstruction with autologous tissue. This flap offers the patients the same advantages as the TRAM flap and avoids its most important disadvantage of potential abdominal wall weakness, by preserving the continuity of the rectus abdominis muscle. The donor site morbidity is thus reduced and recovery is faster. The more complex nature of this procedure leads to increased operating time and requires more demanding surgical skills.</p>

Application of stereotactic core needle biopsy in diagnosis of breast disease / 中华放射学杂志

Objective To evaluate the value of stereotactic core needle biopsy(SCNB)in diagnosis of breast lesions.Methods Forty-seven cases were punctured with computer-assisted stereotactic system, spring-loaded biopsy guns and 16 G core needles.The record of each item was collected,including clinical manifestations,descriptions of the mammographic characteristics(such as calcification,mass and architectural distortion),the pathology of the SCNB and the surgical pathology or mammographic follow-up data.Then the results of SCNB were analyzed based on the comparison of SCNB pathology and the surgical pathology.The reason that SCNB failed and misdioagnosed was inferred from the relationship of SCNB accuracy and the X-ray characteristics.Results Forty-four cases were punctured successfully,3 cases failed.Thirty-one patients were operated soon after biopsy.The results of 27 SCNB cases agreed well with the final pathology but the other 4 did not.Conclusions SCNB as an accurate,time-saving and cost- effective method,is also minimally invasive and hardly changes the architecture of the breast.SCNB can diagnose breast lesions in advance,reduces the number of surgical biopsy,and is promising in clinical application.