Sood Aditya, Daniali Lily N, Rezzadeh Kameron S, Lee Edward S, Keith Jonathan
Department of Surgery, Division of Plastic Surgery, Rutgers University-New Jersey Medical School, Newark, NJ.
Eplasty. 2015 Sep 9;15:e39. eCollection 2015.
A subset of women with locally advanced breast cancer presented with fungating tumor mass eroding and infiltrating the surrounding breast skin (T4b breast cancers). These patients often have chronic pain, large open wounds, frequent infections, malodorous drainage, social isolation, and general debilitation that present enormous therapeutic challenges. Because of the advanced nature of the disease, palliation, while minimizing recovery time and maximizing quality of life, is essential.
From 2009 to 2014, a total of 12 consecutive patients underwent resection of fungating T4b breast tumors and subsequent chest wall reconstruction. Demographic, socioeconomic, and clinical data were collected retrospectively.
Fifty percent of women had distant metastases at the time of reconstruction, and 17% of women presented to the emergency department in a hemodynamically unstable condition in either hemorrhagic shock or septic shock, necessitating delay of reconstruction for up to 1 week. Mean wound size for reconstruction was 473 cm(2). Reconstructive procedures included split-thickness skin grafting and thoracoepigastric advancement, latissimus dorsi, trapezius, and extended transverse and vertical rectus abdominis flaps. Postoperative survival ranged from 98 to 172 days (mean = 127 days), with 9 patients currently living. Seventy-five percent of patients had improved pain and reduced wound care needs after reconstruction. Postoperative reconstruction-specific complications occurred in 33% of cases, with 1 patient requiring a second operating room visit.
Women with fungating T4b breast cancer tumors often present with metastatic disease and have significant need for pain and wound palliation. The reconstructive techniques performed are reliable, efficacious in palliating pain, and reducing wound care needs and have low complication rates.
一部分局部晚期乳腺癌女性患者出现肿瘤呈溃疡性肿块，侵蚀并浸润周围乳腺皮肤（T4b期乳腺癌）。这些患者常伴有慢性疼痛、大面积开放性伤口、频繁感染、恶臭引流液、社交隔离以及全身虚弱，带来了巨大的治疗挑战。由于疾病的晚期性质，在尽量缩短恢复时间并最大化生活质量的同时进行姑息治疗至关重要。
2009年至2014年，共有12例连续患者接受了溃疡性T4b期乳腺肿瘤切除及随后的胸壁重建。回顾性收集了人口统计学、社会经济和临床数据。
50%的女性在重建时已有远处转移，17%的女性因失血性休克或感染性休克导致血流动力学不稳定而被送至急诊科，重建不得不推迟长达1周。重建时的平均伤口面积为473平方厘米。重建手术包括断层皮片移植、胸脐推进皮瓣、背阔肌、斜方肌以及扩大的横行和纵行腹直肌肌皮瓣。术后生存期为98至172天（平均 = 127天），目前有9例患者存活。75%的患者在重建后疼痛得到改善，伤口护理需求减少。33%的病例发生了术后重建相关并发症，1例患者需要再次进入手术室。
患有溃疡性T4b期乳腺癌肿瘤的女性常伴有转移性疾病，对疼痛和伤口姑息治疗有显著需求。所采用的重建技术可靠，在缓解疼痛、减少伤口护理需求方面有效，且并发症发生率低。
