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Reconstrução de parede torácica com retalhos musculocutâneos e fasciocutâneos em pacientes com câncer de mama localmente avançado e metastático / Thoracic wall reconstruction using myocutaneous and fasciocutaneous flaps in patients with locally advanced and metastatic breast cancer
Abdala, Joel; Dutra, Alexandre Katalinic; Domingues, Mauricio Castelo; Yoshimatsu, Eduardo Koiti.
  • Abdala, Joel; A. C. Camargo Cancer Center. São Paulo, SP. BR
  • Dutra, Alexandre Katalinic; A. C. Camargo Cancer Center. São Paulo, SP. BR
  • Domingues, Mauricio Castelo; A. C. Camargo Cancer Center. São Paulo, SP. BR
  • Yoshimatsu, Eduardo Koiti; A. C. Camargo Cancer Center. São Paulo, SP. BR
Rev. bras. cir. plást ; 33(4): 469-477, out.-dez. 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-979965
RESUMO

Introdução:

Câncer de mama localmente avançado é caracterizado pelos estádios clínicos IIIb ou IV e representam de 20 a 25% de todos os casos. A reconstrução dos defeitos é feita com retalhos musculocutâneos e fasciocutâneos, sendo os mais utilizados o latíssimo do dorso e o reto abdominal. O objetivo é avaliar resultados das reconstruções de parede torácica em câncer de mama localmente avançados com retalhos musculocutâneos e fasciocutâneos.

Métodos:

Estudo retrospectivo, observacional descritivo, em único centro. Variáveis estudadas dimensões do defeito e do retalho, tipo de retalho utilizado para a reconstrução, metástases cutâneas e viscerais, evolução pós-operatória e complicações.

Resultados:

11 pacientes, com média de idade de 49 anos, com o lado esquerdo mais acometido. O tipo tumoral mais encontrado foi o carcinoma ductal invasivo. Os retalhos realizados foram 2 latíssimos do dorso com desenho VY (LDVY), 2 latíssimos do dorso associados a retalho toracoabdominal (LDVYTA), 4 verticais do músculo reto do abdome (VRAM) e 3 toracoabdominais (TA). A área média dos defeitos foi 421,72cm2 e a área média dos retalhos utilizados foi de 451cm2. A complicação mais frequente foi deiscência parcial da ferida operatória, presente em 7 pacientes. Da amostra, 6 pacientes atingiram êxito letal. VRAM foi o retalho que apresentou mais complicações. A sobrevida média para VRAM foi de 25,5 meses, para LDVY de 17 meses, TA de 17 meses e LDVYTA de 20,5 meses.

Conclusão:

Os retalhos musculocutâneos e fasciocutâneos são eficazes para a reconstrução da parede torácica após a ressecção de neoplasias mamárias localmente avançadas.
ABSTRACT

Introduction:

Breast cancer is the most common cancer among women worldwide. Locally advanced breast cancer is characterized by clinical stage IIIb or IV and accounts for 20­25% of all cases. Defects are reconstructed using myocutaneous and fasciocutaneous flaps, primarily from the latissimus dorsi and rectus abdominis muscles. The objective is to evaluate the results of thoracic wall reconstructions in cases of locally advanced breast cancer using fasciocutaneous and myocutaneous flaps.

Methods:

This was a retrospective, observational, and descriptive single-center study. Variables studied included defect size and flap dimensions, myocutaneous flap type, presence of cutaneous and visceral metastasis, postoperative evolution, and complications.

Results:

We selected 11 patients with a mean age of 49 years; the left side was the most commonly affected. The most common tumor type was invasive ductal carcinoma. The flaps were made of latissimus dorsi VY (LDVY) in two patients, latissimus dorsi associated with thoracoabdominal flaps (LDVYTA) in two, vertical rectus abdominus myocutaneous flap (VRAM) in four, and thoracoabdominal flaps (TA) in three. The mean defect area was 421.72 cm2, while the mean flap area was 451 cm2. The most frequent complication was partial dehiscence (seven patients). Six patients achieved lethal exit. VRAM flaps presented more complications. The mean survival for VRAM was 25.5 months, LDVY was 17 months, TA was 17 months, LDVYTA was 20.5 months.

Conclusion:

Myocutaneous and fasciocutaneous flaps are effective for chest wall reconstruction after locally advanced breast cancer resection.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Thoracic Injuries / Breast Neoplasms / Carcinoma, Ductal, Breast / Plastic Surgery Procedures / Thoracic Wall / Free Tissue Flaps / Myocutaneous Flap / Neoplasm Metastasis Type of study: Observational study Limits: Adult / Female / Humans Language: English / Portuguese Journal: Rev. bras. cir. plást Journal subject: General Surgery Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: A. C. Camargo Cancer Center/BR

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Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Thoracic Injuries / Breast Neoplasms / Carcinoma, Ductal, Breast / Plastic Surgery Procedures / Thoracic Wall / Free Tissue Flaps / Myocutaneous Flap / Neoplasm Metastasis Type of study: Observational study Limits: Adult / Female / Humans Language: English / Portuguese Journal: Rev. bras. cir. plást Journal subject: General Surgery Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: A. C. Camargo Cancer Center/BR