Técnica de Puckett en el tratamiento de mamas tuberosas con lipotransferencia complementaria / The Puckett Technique for Treating Tuberous Breasts with Complementary Lipotransfer

Introducción: La mama tuberosa es una anomalía congénita de la mama que se presenta en la pubertad y es relativamente frecuente. Objetivo: El objetivo de este artículo es dar a conocer el resultado estético del tratamiento quirúrgico de esta afección con la técnica de Pukett sin incluir el implante mamario, con lipotransferencia complementaria. Presentación del caso: Se presenta una paciente femenina, de 25 años de edad, con mama tuberosa grado 4. Se le realiza corrección con técnica de Pukett sin implantes mamarios y en su lugar se usa grasa autóloga. Luego de corregir las anomalías que conforman esta malformación se obtuvo una mama armoniosa sin complicaciones. Conclusión: La técnica de Pukett combinada con lipotransferencia ofrece resultados estéticos y estables en el tratamiento de la mama tuberosa(AU)

Introduction: Tuberous breast is a congenital breast anomaly that presents at puberty and is relatively frequent. Objective: The aim of this article is to report the aesthetic outcome after treating this condition surgically using the Puckett technique without breast implant, with complementary lipotransfer instead. Case presentation: The is presented of a 25-year-old female patient with grade-4 tuberous breast. She is performed a correction using the Puckett technique without breast implants; autologous fat is used instead. After correcting the anomalies that make up this malformation, a harmonious breast was obtained without complications. Conclusion: The Puckett technique combined with lipotransfer offers aesthetic and stable outcomes in the treatment of tuberous breast(AU)

Application of standardized patient and breast visual palpation simulation system in clinical probation of breast surgery / 中华医学教育探索杂志

Objective:To explore the application effects of standardized patient (SP) and breast visual palpation simulation system on clinical probation of breast surgery for medical students.Methods:A total of 110 students were randomly divided into experimental group and control group, and each group was further divided into 5 subgroups. In the experimental group, SP scripts of five common diseases in breast surgery department were designed according to the syllabus before probation, and the teachers were trained. During the probation, we first talked about the characteristics of disease diagnosis and treatment, and then the five subgroups collected the history of the disease according to the SP of different diseases mentioned above, and checked the corresponding lesions on the breast visual palpation simulation system. In the physical examination, SP responded to the students' questions. The control group also talked about the above-mentioned five diseases during the probation, and then the five subgroups carried out history collection and physical examination for specific patients in the hospital. Finally, the teaching effects were analyzed through medical record writing, theoretical examination, physical examination and student evaluation. SPSS 26.0 was used for chi-square test (or Fisher exact test) and Mann-Whitney U test. Results:There was no significant difference in the theoretical examination between the two groups. It was demonstrated that the correct rate of experimental group was significantly higher than that of the control group in medical history collection, especially in the main symptoms, incentives, aggravation and remission factors, accompanying and differential symptoms and so on. And the positive results of breast, nipple and axillary lymph node palpation in the experimental group were significantly higher than those in the control group through the physical examination operation of breast visual palpation simulation system. The analysis of students' evaluation showed that the teaching efficiency of the experimental group increased, and the students' satisfaction was improved (satisfaction rate: 92.73% vs. 76.36%).Conclusion:The application of SP and breast visual palpation simulation system in breast surgery probation teaching can not only protect the privacy of clinical patients, but also improve the teaching effects, which can be popularized in the clinical teaching of breast surgery.

Anatomy and preservation of the nipple-areola complex / 国际外科学杂志

Preserving nipple-areola complex (NAC) in breast-conserving surgery and nipple-areola complex-sparing mastectomy (NSM) can achieve good tumor safety and breast aesthetics under the premise of appropriate case selection. However, there are still many doubts about the local anatomy of the nipple and NAC and how to preserve the NAC and reshape the shape of the nipple on the basis of selecting cases to achieve individualized treatment and complete tumor resection. In this paper, the NAC, internal nipple and posterior nipple anatomy are described in detail; Combined with the operation of NAC during NSM operation, the treatment of breast duct bundle inside the nipple and behind the nipple were introduced with author′s experience and pictures. The pathologic evaluation of preserving NAC, NAC conservation in breast cancer patients with nipple discharge and radiotherapy after NAC conservation were discussed. In fact, the current situation in our country is that too many patients may be suitable for immediate breast reconstruction or delayed breast reconstruction after NSM. It is very important to be familiar with the local anatomical characteristics of nipples and NAC for standardized breast conserving surgery and NSM. Therefore, more patients with breast cancer can safely retain NAC and breast, and breast reconstruction can be further accomplished on the basis of preserving NAC.

Discussion on the role of goal-oriented comprehensive teaching method in the rotation of breast surgery residents / 中华医学教育探索杂志

Objective:To explore the application effect of the goal-oriented comprehensive teaching method in the rotation of breast surgery residents.Method:A total of 40 residents who rotated in the Department of Breast Surgery of Xiangya Hospital of Central South University from January 2019 to January 2020 were selected as the control group, and another 41 residents who rotated from February 2020 to February 2021 were selected as the study group. The control group adopted the traditional teaching method, while the study group adopted the goal-oriented comprehensive teaching method. The scores of theory and skill operation examination after teaching, nurses' clinical ability before and after teaching and satisfaction with teaching were compared between the two groups. SPSS 25.0 was used for independent sample t test, paired t test and chi-square test. Results:After teaching, the scores of theory and skill operation in the study group were significantly higher than those in the control group [(86.19±4.64) vs. (79.27±5.36), (89.32±5.47) vs. (84.51±6.22)], with statistical differences ( P<0.05). After teaching, the scores of clinical abilities of the two groups were higher than those before teaching ( P<0.05), and the scores of clinical abilities of the study group were higher than those in the control group, with statistical differences ( P<0.05). The satisfaction with teaching form, content, effect and comprehensive evaluation of the study group were higher than that of the control group, with statistical differences ( P<0.05). Conclusion:The application of the goal-oriented comprehensive teaching method in the teaching of rotation training of residents in the department of breast surgery can enhance their learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and improve the teaching quality, with high teaching satisfaction.

Surgical Site Infection (SSI) Surveillance Program for mastectomy in the Department of Surgery of the University of the Philippines-Philippine General Hospital

@#<p style="text-align: justify;"><strong>Background:</strong> Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.</p><p style="text-align: justify;"><strong>Objectives:</strong> The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines - Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program's surveillance follow-up rate.</p><p style="text-align: justify;"><strong>Methods:</strong> This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient's hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.</p><p style="text-align: justify;"><strong>Results:</strong> The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.</p>

Single Shot Paravertebral Block - A Novel Approach for Post-Operative Analgesia in Breast Surgeries

Advancements in diagnostic sciences have led to increased frequency in detection of cases of breast cancer. After confirmation, majority of these patients undergo definitive surgeries commonly Modified Radical Mastectomy or Lumpectomy under general anaesthesia. In addition to inadequate pain control there is increased incidence of nausea and vomiting during first 24 hrs. of the post-operative period with GA. Parenteral narcotic used routinely in postoperative period further increases nausea and vomiting. The large number of patients hospitalized annually for breast cancer surgeries results in heavy costs and long hospital stays. Regional anaesthesia using prep-incisional paravertebral block (PVB) maybe an ideal alternative to GA alone for breast cancer surgery. Benefits include prolonged postoperative pain relief, reduction in postoperative nausea and vomiting and has potential for early discharge. It results in unilateral sensory, motor and sympathetic blockade with additional advantages of lower side effect profile, early mobilization and fewer contraindications. We wanted to study the efficacy of paravertebral block for postoperative pain relief in breast surgeries. METHODSA prospective, randomized, comparative study involving 60 adult female patients posted for Ca breast surgery was conducted. One group received pre-incisional PVB with GA (group A) and another received GA alone (group B). The efficacy of analgesia and PONV were assessed using Visual Analogue Scale and Numeric Rating Score respectively at T1, 2, 3, 4, 5, 6, 12, 24, 48 hours. Fentanyl 2 mic / Kg as rescue analgesic and ondansetron 0.1 mg / Kg as antiemetic were given at VAS >/= 4 and NRS >/= 2. Total opioid and antiemetic consumption was noted. RESULTSTotal VAS and NRS scores of Group A was significantly lower than Group B. Also significantly reduced consumption of analgesic and antiemetic was observed in Group A. ∑VASA = (3.37 + 2.76) while ∑ VASB = (19.23 + 3.32) while, Group A ∑NRS = (0.47 + 0.67) and Group B ∑NRS = (5.27 + 1.34). CONCLUSIONSPVB provides significant pain relief with decreased incidence of PONV and has the additional advantage of lesser consumption of opioids and antiemetics in the immediate postoperative period.

Update in clinical research on oncoplastic breast surgery in China / 中国肿瘤临床

the survival of patients with breast cancer has remarkably improved. In particular, oncoplastic breast surgery has gained momentum due to its positive impact on patients' quality of life. Oncoplastic breast conservation surgery and postmastectomy breast reconstruction are the two main branches of this frontier discipline. Although oncoplastic breast surgery gained scholarly attention in China later than in Western countries, considerable development and progress has been made over the last few decades. Here, we aimed to summarize the academic achievements of Chinese oncoplastic surgeons in implant-based breast reconstruction, autologous tissue breast reconstruction, mammoplasty by lipofilling, endoscope-assisted breast reconstruction, and nipple-areola reconstruction. we also summarized patient-reported outcomes. The drawbacks of the current investigations will be discussed along with the directions for future clinical practice and research.

Analgesia para cirugía de mama / Analgesia for breast surgery

Resumen: El dolor postoperatorio se espera moderado a severo en las primeras 24 horas después de mastectomía, este dolor puede no resolverse en 10% de las cirugías, y puede persistir hasta después de seis meses en 53% de las pacientes. El síndrome doloroso postmastectomía (SDPM), también llamado neuralgia intercostobraquial, suele presentarse después de una cirugía total o segmentaria, y puede persistir por meses o años, en 20-68% de las pacientes. Inicia en el postoperatorio inmediato, es de intensidad moderada y de características neuropáticas. Los factores asociados con este tipo de dolor además del tipo de cirugía son: la quimioterapia neoadyuvante previa, tumores en cuadrantes superiores, resección mamaria previa, enfermedad metastásica, receptores hormonales positivos, manejo con terapia endocrina, radioterapia y el grado de malignidad del tumor. Nuevas estrategias analgésicas en el perioperatorio han surgido en los últimos años, como son el uso de gabapentinoides, lidocaína y nuevos bloqueos regionales como el bloqueo del plano del erector spinae, bloqueo del serrato, BRILMA, PEC1 y PEC2, las cuales son estrategias efectivas en dolor agudo y que, actualmente, se analiza su impacto a largo plazo (este artículo puede ser consultado en versión completa en http://www.painoutmexico.com).

Abstract: Postoperative pain is moderate to severe in the first 24 hours after mastectomy, this pain may not resolve in 10% of surgeries, and may persist until after six months in 53% of patients. Postmastectomy pain syndrome (SDPM), also called intercosto-brachial neuralgia, may persist for months or years, in 20-68% of patients. It begins in the immediate postoperative period, is of moderate intensity and of neuropathic characteristics. The factors associated with this type of pain as well as the type of surgery are: prior neo-adjuvant chemotherapy, tumors in upper quadrants, previous mammary resection, metastatic disease, positive hormonal receptors, management with endocrine therapy, radiotherapy and the degree of malignancy of the tumor. New analgesic strategies in the perioperative have emerged in recent years, such as: the use of gabapentinoids, lidocaine and new regional blocks such as blockade of the erector spinae plane, serratus blockade, BRILMA, PEC1 and PEC2, which are effective strategies in acute pain and that is currently analyzing its long-term impact (full version is available inhttp://www.painoutmexico.com ) .

Serratus anterior plane block combined with monitored anesthesia care for surgery of lateral side of breast: a case report / 대한마취과학회지

BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques. CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS: Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.

Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery: a case report / 대한마취과학회지

BACKGROUND: The breast is innervated by the intercostal nerves and the brachial plexus. We propose a technique to perform breast surgery without general anesthesia using the erector spinae plane (ESP) block and selective block of four nerves that arise from the brachial plexus innervate the breast and the axilla (SBP block). CASE: A 77-year-old man with breast cancer was scheduled for radical mastectomy and axillary clearance. He had a previous history of myocardial infarction with dilated cardiomyopathy and severely impaired ejection fraction. The surgery was performed under regional anesthesia with combined ESP and SBP block. The patient did not require opioids or other supplemental analgesics intra- or postoperatively and was discharged uneventfully. CONCLUSIONS: SBP is a novel block that selectively blocks branches of the brachial plexus that innervate the breast.

Responsibility and status of breast surgeons in breast reconstruction / 中国实用外科杂志

Mastectomy is still the main surgery method to treat breast cancer in China.Breast surgeons should be more devoted to breast reconstruction.Although different reconstruction methods should comprehensively consider the patient's wishes and the doctor's technical ability and other factors,it is necessary for breast surgeons to adhere to the principle of tumor safety,reasonably design the incision of breast surgery,master the technology of preserving the nipple areola complex,and separate the thickness and scope of the flap.Under the mode of multidisciplinary cooperation,breast surgeons should actively participate in the training,keep learning and practicing,make effort to improve the overall treatment level of breast cancer patients and promote the standardized process of breast reconstruction after breast cancer surgery in China.

Thoughts on breast reconstruction after breast cancer surgery in China / 中国实用外科杂志

Oncoplastic breast reconstruction has become an important component of comprehensive therapy for breast cancer.Strong collaborations of physicians,patients and society are warranted to build a normalized and professional mode and pathway for oncoplastic breast reconstruction in China.Both oncological safety and cosmetic well-being are key requirements for the design,procedure and assessment of oncoplastic breast reconstruction.The principles of comprehensive therapy and oncological considerations should not be compromised and should always take precedence.Breast surgeons should recommend and perform the oncoplastic breast reconstructions with objective understanding and cautious assessment,and strictly follow the recommendations of professional consensus as well as the principles of personalized treatment.Closely multidisciplinary collaborations with plastic surgeons are recommended to achieve a balanced oncoplastic safety and cosmetic "well-being.

Avaliação da influência da radioterapia nas reconstruções de mama com TRAM / Evaluation of the effects of radiotherapy on breast reconstruction with a transverse rectus abdominis myocutaneous flap

Introdução: A radiação influencia negativamente os resultados das reconstruções de mama que utilizam implantes. No entanto, os efeitos da radiação sobre as reconstruções de mama apenas com tecidos autólogos ainda não está clara. O objetivo do trabalho é avaliar as complicações pós-operatórias de pacientes submetidas à reconstrução de mama com retalho do músculo reto abdominal (TRAM) imediato e tardio e correlacionar estatisticamente essas complicações com a presença ou não da radioterapia (RT). Métodos: Levantamento retrospectivo de prontuários de pacientes submetidas à reconstrução mamária, das quais 126 pacientes realizaram reconstrução mamária com TRAM no período de 2004 a 2011. Foram analisadas a presença ou não de RT e as complicações pós-operatórias nas reconstruções imediatas e tardias. As pacientes foram divididas em 3 grupos: 1) sem RT (somente TRAM), 2) (TRAM→RT), 3) (RT→TRAM). Para cada grupo foi avaliada a presença e ausência de complicações menores e maiores e aplicados testes estatísticos. Resultados: Os grupos estudados foram considerados homogêneos quanto a idade e índice de massa corporal. Houve maior incidência de complicações maiores nos grupos com RT após o TRAM (29,6%) em relação aos demais grupos: sem RT (23,4%) e RT antes do TRAM (5,6%). Entretanto, a diferença entre os grupos não se mostra estatisticamente significativa. Para as Complicações Menores, também não há evidências de diferenças estatisticamente significativas entre os grupos. Conclusão: Nesse estudo a radioterapia adjuvante não se mostrou como fator potencializador de complicações nas pacientes submetidas à reconstrução imediata com TRAM pós-mastectomia.

Introduction: Radiation negatively influences the results of breast reconstruction using implants. However, the effects of radiation on breast reconstruction with autologous tissue is still unclear. The objective of this study was to evaluate the postoperative complications in patients who underwent immediate and late breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap and statistically correlate these complications with the use of radiotherapy (RT). Methods: A retrospective survey of the medical records of patients who underwent breast reconstruction was conducted. Of the patients, 126 underwent breast reconstruction with a TRAM flap between 2004 and 2011. The presence or absence of RT and postoperative complications in the immediate and late reconstructions was assessed. The patients were divided into 3 groups as follows: 1) without RT (TRAM alone group), 2) TRAM→RT group, and 3) RT→TRAM group. The patients in each group were evaluated for the presence and absence of minor and major complications, and results were statistically analyzed. Results: The groups were considered homogenous for age and body mass index. The incidence of major complications was higher in the groups with RT after TRAM (29.6%) than in the other groups, namely the groups without RT (23.4%) and with RT before TRAM flap reconstruction (5.6%). However, the differences among the groups were not statistically significant. No evidence of statistically significant differences in minor complications were found among the groups. Conclusion: In this study, adjuvant RT was not a potentiating factor of complications in the patients who underwent immediate reconstruction with a TRAM flap after mastectomy.

Impacto de la cirugía mamaría en la lactancia materna / The impact of breast surgery on breastfeeding

La lactancia materna para la mujer es un periodo vital, el que es influido por diferentes factores, entre estos, está el antecedente de cirugía mamaria. El propósito de esta revisión es explorar, en la evidencia disponible, el impacto que tienen los implantes mamarios y la reducción mamaria en el amamantamiento. Esto, con el fin de apoyar el trabajo con las mujeres en el proceso de lactancia materna e informar previamente a las usuarias cómo estas cirugías podrían afectar su proceso. Con respecto a las características de la cirugía, hay diferencias en los efectos que puede tener en la producción de leche, según: el tipo de cirugía, tipo de abordaje y el sitio de incisión, que puede afectar a corto y largo plazo. Debido a que existe evidencia heterogénea con respecto al impacto de la cirugía mamaria en la lactancia materna, toma un rol importante considerar en la evaluación este antecedente en la mujer, para realizar un buen diagnóstico. Ante todo, es importante el apoyo y guía educativa, tanto prenatal como en el puerperio, para empoderar a las mujeres en la toma de decisiones y el manejo de su lactancia materna, previo a la cirugía y durante el proceso de lactancia materna. Para lograr esto se necesita personal de salud capacitado, que pueda intervenir en esta realidad, informado, con la mejor evidencia disponible.

Breastfeeding is a vital period for women and it's influenced by different factors such as breast surgery. The purpose of this review is to explore available evidence on the impact that some breast surgeries (breast implants or breast reduction) have on breastfeeding. This is to support the breastfeeding process in this women, and also to inform them how these surgeries could affect on their breastfeeding process. There are several factors related to surgery that can influence on the breastfeeding process, such as the type of approach, the incision siteand, in the case of the implant, where it is located, which may affect short or long term. Because there are not enough studies, and there is also heterogeneous evidence regarding the impact of breast surgery on breastfeeding, it is important the educational support be given both prior to surgery and during the pre and postnatal phases. To achieve this the trained health professionals need to be informed and with the best evidence available related to the breastfeeding process.

Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report / 대한마취과학회지

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.

Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report / 대한마취과학회지

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.

Clinical study on the perioperative psychological intervention and intraoperative perfusion of total saponins in patients with breast hematoma and skin stasis after operation / 中国生化药物杂志

Objective To study the clinical treatment effect of intraoperative perfusion of Panax notoginseng saponins on the postoperative mammary gland hematoma and skin ecchymosis. Methods A total of 100 patients who underwent breast minimally invasive surgery from August 2015 to May 2016 in Wenling First People's Hospital were randomly divided into control group and experimental group 50 cases in each group.The control group underwent intraoperative perfusion of Panax notoginseng saponin,on the basis of this, the experimental group were given psychological intervention, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patients, increased the patient's treatment confidence and treatment compliance. The clinical indicators of the experimental group and the control group were compared. Results After the corresponding treatment, the incidence of postoperative hematoma in the experimental group (4.0%) was significantly lower than in the control group (12.0%), the difference was statistically significant (P<0.05). The probability of skin staining in control group (26.0%) was significantly higher than that in the experimental group (8.0%), the difference was statistically significant (P<0.05). Conclusion Breast minimally invasive biopsy perioperative psychological intervention, intraoperative perfusion of panax notoginseng saponins can reduce the incidence of postoperative mammary gland hematoma, skin ecchymosis.

Clinical study on the perioperative psychological intervention and intraoperative perfusion of total saponins in patients with breast hematoma and skin stasis after operation / 中国生化药物杂志

Objective To study the clinical treatment effect of intraoperative perfusion of Panax notoginseng saponins on the postoperative mammary gland hematoma and skin ecchymosis. Methods A total of 100 patients who underwent breast minimally invasive surgery from August 2015 to May 2016 in Wenling First People's Hospital were randomly divided into control group and experimental group 50 cases in each group.The control group underwent intraoperative perfusion of Panax notoginseng saponin,on the basis of this, the experimental group were given psychological intervention, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patients, increased the patient's treatment confidence and treatment compliance. The clinical indicators of the experimental group and the control group were compared. Results After the corresponding treatment, the incidence of postoperative hematoma in the experimental group (4.0%) was significantly lower than in the control group (12.0%), the difference was statistically significant (P<0.05). The probability of skin staining in control group (26.0%) was significantly higher than that in the experimental group (8.0%), the difference was statistically significant (P<0.05). Conclusion Breast minimally invasive biopsy perioperative psychological intervention, intraoperative perfusion of panax notoginseng saponins can reduce the incidence of postoperative mammary gland hematoma, skin ecchymosis.

Pedicle omentum flap harvested by laparoscopy in breast oncoplastic sugery / 中国癌症杂志

Surgery is one of the most important treatments for breast cancer. A part of the early breast cancer patients demand further oncoplastic breast surgery to reconstruct or restore the breast cosmosis after conventional breast conserving surgery, by oncoplastic breast surgery, which is a modern conception and technique including volume dis-placement and volume replacement. Oncoplastic breast surgery using pedicled omental flap is a new approach among volume replacement techniques. It has made some progress in recently years. A systematic review was therefore con-ducted to analyze and illuminate the present status.

Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery / Bloqueio paravertebral no controle da dor aguda pós-operatória e dor neuropática do nervo intercostobraquial em cirurgia mamária de grande porte

Abstract Background: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. Objectives: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24 h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. Methods: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine + adrenaline 3 µg mL−1 with a volume of 0.3 mL kg−1 preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24 h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0 h, 1 h, 6 h and 24 h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. Results: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24 h of study 0 h 1.90 (±2.59) versus 0.88 (±1.5) 1 h 2.23 (±2.2) versus 1.53 (±1.8) 6 h 1.15 (±1.3) versus 0.35 (±0.8); 24 h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0 h and 6 h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0 h 2.95 (±3.1) versus 1.55 (±2.1); 1 h 3.90 (±2.7) versus 2.43 (±1.9) 6 h 2.75 (±2.2) versus 1.68 (±1.5); 24 h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38 ± 0.81 µg kg−1 versus 3.51 ± 0.81 µg kg−1) and morphine (3.5 mg ± 3.4 versus 7 mg ± 6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. Conclusions: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

Resumo Justificativa: Estão descritas várias técnicas locorregionais para a abordagem da dor aguda e dor crônica após cirurgia de mama. O ideal seria uma técnica fácil de fazer, reprodutível, com pouco desconforto para as doentes, com poucas complicações e que permitirá um bom controle da dor aguda e uma diminuição da incidência de dor crônica, notadamente dor neuropática do intercostobraquial, por ser a entidade mais frequente. Objetivos: Estudar a aplicação de bloqueio paravertebral com picada única no pré-operatório de cirurgia mamária de grande porte. Avaliar numa primeira fase o controle de dor aguda e náuseas-vômitos no pós-operatório (NVPO) nas primeiras 24 horas e numa segunda fase a incidência de dor neuropática na região do nervo intercostobraquial seis meses após a cirurgia. Métodos: Foram incluídas 80 doentes do sexo feminino, ASA I-II, entre 18 e 70 anos, submetidas a cirurgia mamária de grande porte sob anestesia geral, estratificadas em dois grupos: anestesia geral (anestesia geral inalatória com opioides segundo resposta hemodinâmica) e paravertebral (bloqueio paravertebral com picada única em T4 com ropivacaína 0,5% + adrenalina 3 µg/mL com um volume de 0,3 mL/kg pré-operatoriamente e posterior indução e manutenção com anestesia geral inalatória). No pós-operatório imediato foi colocada PCA (Patient-controlled analgesia) de morfina programada com bolus a demanda durante 24 horas. Foram registados fentanil intraoperatório, consumo de morfina pós-operatória, complicações relacionadas com as técnicas, dor em repouso e ao movimento a 0, 1 h, 6 h e 24 h, assim como os episódios de NVPO. Foram analisadas todas as variáveis identificadas como fatores de cronificação da dor idade, tipo de cirurgia, ansiedade segundo escala de HADS (Hospital Anxiety and Depression scale), dor pré-operatória; acompanhamento no domicílio; índice de massa corporal (IMC), tratamentos adjuvantes de quimioterapia/radioterapia e foi verificada a homogeneidade das amostras. Aos seis meses da cirurgia foi avaliada, segundo escala DN4, a incidência de dor neuropática na área do nervo intercostobraquial. Resultados: O grupo paravertebral teve valores de VAS (Escala Visual Analógica) em repouso mais baixos ao longo das 24 horas de estudo 0 h 1,90 (± 2,59) versus 0,88 (± 1,5); 1 h 2,23 (± 2,2) versus 1,53 (± 1,8); 6 h 1,15 (± 1,3) versus 0,35 (± 0,8); 24 h 0,55 (± 0,9) versus 0,25 (± 0,8) com significado estatístico às 0 e às 6 horas. Em relação ao movimento o grupo paravertebral teve valores de VAS mais baixos e com significância estatística nos quatro momentos de avaliação: 0 h 2,95 (± 3,1) versus 1,55 (± 2,1); 1 h 3,90 (± 2,7) versus 2,43 (± 1,9) 6 h 2,75 (± 2,2) versus 1,68 (± 1,5); 24 h 2,43 (± 2,4) versus 1,00 (± 1,4). O grupo paravertebral consumiu menos fentanil (2,38 ± 0,81 µg/Kg versus 3,51 ± 0,81 µg/Kg) e menos morfina no pós-operatório (3,5 mg ± 3,4 versus 7 mg ± 6,4), com diferença estatisticamente significativa. Na avaliação de dor crônica aos seis meses no grupo paravertebral houve menos casos de dor neuropática na região do nervo intercostobraquial (três versus sete) embora sem significância estatística. Conclusões: O bloqueio paravertebral com picada única permite um adequado controle da dor aguda com menor consumo de opioides intraopreatórios e pós-operatórios, mas aparentemente não consegue evitar a cronificação da dor. Mais estudos são necessários para esclarecer o papel do bloqueio paravertebral na cronificação da dor em cirurgia mamária de grande porte.