| Part Ⅰ Current trends of breast reconstruction after mastectomy for breast cancer patients in China[Background] To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a questionnaire survey in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.[Methods] We designed a questionnaire for this study; all data were collected until 2012.12.31. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By July-2013,41 questionnaires (response rate 78.8%) had been returned. Among all,5 were excluded for not performing BR.[Results] These 36 hospitals cover 22 out of 34 provinces and municipalities (64.7%) in China. A total of 538 surgeons worked in the general surgery or oncological surgery department, but only 123(22.9%) were qualified to perform BR. In 2012, except for 4 missing data,24,763 mastectomies were performed in 32 hospitals; among them,1120(4.5%) received BR. According to these 36 respondents,32 performed prosthetic (1,843 cases in all) while 32 performed latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1,703 cases in all) from the time of their first BR operation to the end of 2012. During the same period,366 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 28 hospitals, while 155 free abdominal BR, which requiring technique of microsurgery, were carried out in 9 hospitals. The overall complication rate of BR was 18.2%. All respondents reached a consensus on the low to medium effect of radiotherapy on increasing the operational difficulties and influencing the esthetic outcomes of BR. Regarding chemotherapy, most respondents concluded that it had a non-effect or low effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.[Conclusion] With more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the framework of multi-disciplinary, the training for doctors and the educational program for patients, etc.Part Ⅱ Single-center report of 132 cases of free abdominal flaps for breast reconstruction[Objective] Along with the development of diagnosis and treatment technology,the disease free survival and overall survival of breast cancer have been extended. In order to improve the quality of life after mastectomy, more and more breast reconstructions were applied in breast cancer patients. We retrospectively reviewed 132 cases of free abdominal flaps for breast reconstruction performed in Fudan University Shanghai Cancer Center. Clinical outcomes, reconstructive techniques and expriences are discussed.[Methods] From November 2006 to February 2014, we used free abdominal flaps to perform 132 cases of breast reconstruction on 131 female patients after mastectomy. We observed the surgery, complications and safety.[Results] We performed 132 cases of flaps based on deep inferior epigastric vessels. The average operation time was 7.71h. The average time of ischemia was 79.00min. The average anastomosis time was 59.84min. The average number of perforators included in the flap was 3. The internal thoracic vessels were preferred recipient vessels. Ten cases of vessel crisis occurred and 6 of them were venous thrombosis and 4 cases were venous kink. Seven of them were salvaged, and the other 3 failed, the success rate was 97.72%. Postoperative infection rate was 6.06%. Abdominal bulge occurred in 3.03% of patients. None of the patients developed abdominal hernia. The median interval between surgery and the first cycle of adjuvant chemotherapy was 19 days. The median follow-up time was 21 months. Two cases of local recurrence, one case of secondary primary and distant metastasis were reported.[Conclusions] Although free abdominal flap breast reconstruction requires complicated microsurgical techniques, and the learning curve does exist, free abdominal flap breast reconstruction has a high success rate with oncological safety and few complications.Part Ⅲ Application of Near-Infrared Spectroscopy in the monitoring procedure of free abdominal flap[Background] Free abdominal flap has become more and more popular in the field of breast reconstruction for breast cancer patients. As the time passing, increasing cases and matured technique as well as traditional post-operative monitoring methods have made a more than 95% flap survival rate. However, traditional monitoring methods are time and energy consuming, the subjective and empirical results put great stress on the surgeons and patients. A new adjuvant monitoring method needs to be adopted in this procedure.[Methods] We adopted Near-Infrared Spectroscopy (NIRS) in the pre-, intra- and post-operative monitoring procedure for patients received free abdominal flap breast reconstruction in Fudan University Shanghai Cancer Center from August 1,2012 to February 28,2014. After data collection and analysis, we evaluate the feasibility of NIRS in predicting the occurence of vascular crisis. At the same time, we use NIRS to evaluate the blood supply distribution of the flap, in order to find the related factors, and finally evaluate the applied value of NIRS in flap monitoring procedure.[Results] Forty-one patients’free abdominal flaps had NIRS monitored during the study period. The results of pre-operative monitoring revealed the better blood supply in the medial regions, which may result from the abundant perforators of inferior epigastric vessels around the umbilicus. The results of intra-operative monitoring when the flap was supplied only by the vascular pedicle revealed the obvious blood obstruction in region Ⅳ, indicating the high sensitivity of NIRS. The results of post-operative monitoring revealed the blood supply weakened from region Ⅰ to Ⅲ, and the blood supply to region Ⅲ was related to reconstruction timing and the weight of breast for immediate breast reconstruction patients. The length of surgical time and anastomosis time had a relationship with tissue Hemoglobin Index (tHI) in region Ⅲ. What’s more, NIRS can distinguish vascular crisis from partial flap loss and congestion of breast skin. During the study period, NIRS successfully detected a vascular crisis before clinical observation, which indicated the highly applied value of NIRS in post-operative monitoring procedure.[Conclusions] NIRS can detect the change of blood supply in the pre-, intra-and post-operative time. It can also detect the occurrence of vascular crisis. The real-time, non-invasive, continuous monitoring method and objective, reliable indicators make NIRS suitable in the monitoring procedure for free abdominal flap, which may improve the survival rate of flap, reduce the pressure on the monitoring teem and establish the foundation for the popularization of free abdominal flap breast reconstruction. |
PDF Full Text Request