Dataset Information

Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: a retrospective case-control study.

ABSTRACT:

Objective

Breast cancer treatment has evolved to the modern skin-sparing mastectomy and nipple-sparing mastectomy. To better perform these surgeries, minimally invasive techniques using the endoscope, or Da Vinci Robotic Surgery platform have been developed. The deep inferior epigastric perforator (DIEP) flap is the gold standard in breast reconstruction, but it is still not commonly performed after minimally invasive mastectomy due technical difficulty. Here the authors introduced six key steps to a successful aesthetic autologous free flap reconstruction in in minimally invasive mastectomies.

Methods

There are six main steps to our technique: placement of mastectomy incision, precise flap design after angiography studies, trial of shaping, transcutaneous medial suture, footprint recreation and postoperative shaping with bra. Between November 2018 and July 2022, a total of 67 immediate breast reconstructions using free perforator flaps were performed in 63 patients after minimally invasive nipple-sparing mastectomy.

Results

The results from the minimally invasive mastectomy group were compared with a group of conventional mastectomy patients ( n= 41) performed during the same period. There were no significant differences in flap exploration rates. One hundred percent of the flaps survived. In the minimally invasive group, the final scar was placed in the lateral region, where it would be hidden from the anterior view. Only 70.7% of the conventional mastectomy group could achieve a hidden lateral scar ( P <0.001). The aesthetic revision rates were similar between two groups.

Conclusion

With attention to the six steps above, autologous free flap reconstruction can be offered reliably in the setting of minimally invasive mastectomy.

SUBMITTER: Wong AW

PROVIDER: S-EPMC10871604 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: a retrospective case-control study.

Wong Allen Wei-Jiat AW Kuo Wen-Ling WL Cheong David Chon-Fok DC Tsai Hsiu-Pei HP Kao Shu-Wei SW Chen Chia-Fang CF Huang Jung-Ju JJ

International journal of surgery (London, England) 20240201 2

<h4>Objective</h4>Breast cancer treatment has evolved to the modern skin-sparing mastectomy and nipple-sparing mastectomy. To better perform these surgeries, minimally invasive techniques using the endoscope, or Da Vinci Robotic Surgery platform have been developed. The deep inferior epigastric perforator (DIEP) flap is the gold standard in breast reconstruction, but it is still not commonly performed after minimally invasive mastectomy due technical difficulty. Here the authors introduced six k ...[more]

PMID: 38000051

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Project description:BackgroundFluid management of the surgical patient has undergone a paradigm shift over the past decade. A change from 'wet' to 'dry' to a 'goal-directed' approach has been witnessed. The fluid management of patients undergoing free flap reconstruction is particularly challenging. This is typically a long operation with minimal surgical stimulation, and hypotension often ensues. The use of vasopressors in these cases is contraindicated to maintain adequate flow to the flap. Hypotension is often treated with intravenous fluid boluses. However, aggressive fluid administration to maintain adequate blood pressure can result in flap edema, venous engorgement and, ultimately, flap loss.ObjectiveThe primary objective of the present study was to determine whether goal-directed fluid therapy, titrated to maintain stroke volume variation ≤13%, with the use of an arterial pulse contour device results in improved postoperative cardiac index (CI) and stroke volume index (SVI) with reduced amounts of intravenous fluid. The primary end points studied were CI, SVI and cumulative crystalloid/colloid administration.MethodsTwenty female patients undergoing simultaneous microvascular free flap reconstruction immediately following mastectomy were studied. Preoperative and intraoperative care were standardized. Each patient received intra-arterial blood pressure monitoring. In all patients, cardiac output measurement occurred throughout the intraoperative period using the arterial pulse contour device. Control patients had their fluid administered at the discretion of the anesthesiologist (blinded to results from the cardiac output device). Patients in the intervention group had a baseline crystalloid infusion of 5 mL/kg/h, with intravenous colloid boluses to maintain a stroke volume variation ≤13%.ResultsThere was no difference in heart rate or mean arterial pressure between groups at the end of the operation. However, at the end of the operation, the intervention group had significantly higher mean (± SD) CI (3.8±0.8 L/min/m(2) versus 3.0±0.5 L/min/m(2); P=0.02) and SVI (51.4±2.4 mL/m(2) versus 43.3±2.3 mL/m(2); P=0.03). This improved CI and SVI was achieved with similar amounts of administered intraoperative fluid (5.8±0.5 mL/kg/h versus 5.0±0.7 mL/kg/h, control versus intervention). The intervention group required less postoperative fluid resuscitation during the early postoperative period (total fluid administered from end of operation to midnight of the operative day, 6.4±1.9 mL/kg/h versus 10.2±3.3 mL/kg/h, intervention versus control, respectively, P<0.01).DiscussionGoal-directed fluid therapy using minimally invasive cardiac output monitoring resulted in improved end-operative hemodynamics, with less 'rescue' fluid administration during the perioperative period.

Project description:Background: Injuries to the digital distal phalanx often result in functional impairments such as loss of grip and sensation, along with aesthetic challenges. Various reconstructive techniques, including the use of adipofascial flaps, have been explored to address these issues. The homodigital dorsal adipofascial reverse flap (HDARF) has demonstrated promising results in restoring both functionality and aesthetics. However, a comparative evaluation between adipofascial flaps and other commonly used techniques, such as V-Y advancement flaps and cross-finger flaps, remains limited. Objective: This retrospective study evaluates the long-term functional and aesthetic outcomes of adipofascial flap reconstructions for pulp defects, focusing on sensory recovery and patient satisfaction. Methods: Between 2010 and 2022, 20 patients (14 men, 6 women) with digital pulp defects underwent reconstruction using adipofascial flaps in a single-stage procedure. Injuries included avulsion and crush injuries, distributed across various digits. Sensory recovery was assessed using the Semmes-Weinstein monofilament test and two-point discrimination. Joint mobility, cold intolerance, and aesthetic satisfaction were also evaluated. Results: All flaps were successfully reconstructed within 24 h of trauma. Sensory recovery was excellent, with Semmes-Weinstein scores ranging from 1.65 to 2.83, comparable to the uninjured hand. Two-point discrimination averaged 1-5 mm in most cases. Cold intolerance persisted in four patients, and mild nail dystrophy was noted in three cases, with one case of nail absence. Aesthetic satisfaction was high in 19 patients. Conclusions: The adipofascial flap effectively restores function and aesthetics in pulp defects, offering superior sensory recovery, high patient satisfaction, and minimal complications. Its regenerative potential and adaptability make it a valuable option for fingertip reconstruction, supporting its continued use in clinical practice.

Dataset Information

Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: a retrospective case-control study.

Objective

Methods

Results

Conclusion

Publications

Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: a retrospective case-control study.

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