Clinical results of autologous reconstruction with DIEP flap following nipple-sparing mastectomy / 中国实用外科杂志

OBJECTIVE: To analyze the clinical results of autologous reconstruction with DIEP flap following nipplesparing mastectomy and summarize experience.METHODS: From January 2016 to October 2018,DIEP flaps were utilized in 81 surgical cases of immediate breast reconstruction after mastectomy in Huashan Hospital of Fudan University.Success rate,safety,complications and patient satisfaction of nipple-sparing mastectomy(NSM) group(38 cases) and non-NSM(NNSM) group(43 cases) were compared.RESULTS: All DIEP flaps in 81 cases were successful with a flap survival rate of 100%.No skin necrosis,infection,or seroma occurred.There were 1 case(2.6%) of vascular complication and 2 cases(5.3%)of partial fat necrosis in NSM group,and 2 cases(4.7%) of vascular complication and 2 cases(4.7%) of partial fat necrosis in non-NSM group.No statistically significant difference was found between groups.Three cases of partial NAC ischemia(7.9%) happened in NSM group with no complete necrosis.There was a greater satisfaction in NSM group(81.6%) than non-NSM group(72.1%) on the overall impression of breast reconstruction in 6 months after surgeries,but the difference was not significant(P=0.315).Over a median follow-up period of 22 months,no local recurrence or distant metastasis were observed.CONCLUSION: Autologous reconstruction with DIEP flap following nipple-sparing mastectomy is safe and reliable for carefully selected patients when operations are executed with proficient operative skills.Complications are similar in the approach compared with DIEP flap immediate breast reconstruction following non-NSM.The technique has a controllable rate of NAC necrosis and offers the advantage of cosmetic effect.

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.

Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Drug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism.</p><p><b>METHODS</b>From September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively, intraoperatively, and postoperatively.</p><p><b>RESULTS</b>A total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90 +/- 67.42) ng/L, (433.80 +/- 243.72) ng/L, (48.80 +/- 42.69) ng/L, (229.04 +/- 172.68) ng/L and (232.39 +/- 224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients.</p><p><b>CONCLUSIONS</b>The total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.</p>