Soumian Soni, Parmeshwar Rishikesh, Chandarana Mihir, Marla Sekhar, Narayanan Sankaran, Shetty Geeta
Department of Breast and General Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
Department of Breast and General Surgery, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.
Arch Plast Surg. 2020 Mar;47(2):153-159. doi: 10.5999/aps.2019.01186. Epub 2020 Mar 15.
Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit.
All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates.
One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers.
Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.
基于肋间动脉和胸外侧动脉分支的穿支动脉皮瓣可用于保乳手术（BCS）后的重建。尽管十多年前就有相关描述，但这些皮瓣在临床实践中尚未得到广泛应用。我们通过一项前瞻性多中心审计报告了使用胸壁穿支皮瓣进行部分乳房重建的短期和长期手术结果。
分析2015年1月至2018年10月期间所有接受BCS并使用肋间动脉穿支或胸外侧动脉穿支皮瓣进行部分乳房重建的患者。经过适当培训的肿瘤整形乳房外科医生将所有肿瘤切除和重建作为一期手术进行。记录患者特征、治疗细节和手术结果。记录的具体结果为切缘再次切除情况和并发症发生率。
在给定的研究期间，112例患者接受了该手术。中位年龄为54岁。标本中位重量为62.5 g，切除中位体积为121.4 mL。15例患者（13.39%）因切缘接近或阳性而进行了切缘再次切除，且无额外的发病率增加。1例患者需要进行全乳切除术。8例患者（7.14%）发生早期并发症。没有患者需要进行对侧对称手术。各参与中心的结果具有可比性。
基于胸壁动脉穿支的皮瓣是外侧和下象限部分乳房重建的极佳选择。短期和长期手术结果在各部位具有可比性，且手术发病率极低。需要研究患者报告的结局指标。
