Campana Luca G, Balestrieri Nicola, Menin Nicola
Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK.
Breast Unit, ULSS 2 Marca Trevigiana, Vittorio Veneto, Italy.
J Surg Case Rep. 2022 May 18;2022(5):rjac199. doi: 10.1093/jscr/rjac199. eCollection 2022 May.
A 55-year-old woman with previous skin-sparing mastectomy and prosthetic reconstruction for multifocal ductal carcinoma developed homolateral axillary recurrence. Following nodal dissection, partial periprosthetic capsulectomy and the overlying breast skin excision, the pathology report revealed a positive cutaneous margin. Since further breast skin excision or radiotherapy would have compromised the prosthetic implant, and the patient was adamant about avoiding any endangering intervention, the multidisciplinary recommendation included skin-directed electrochemotherapy (ECT) in the frame of a multimodal treatment strategy. The procedure lasted 20 minutes under mild general sedation and included a bolus of intravenous bleomycin followed by local application of electric pulses using a needle electrode. The postprocedural course was uneventful, except for mild dermatologic toxicity. At 5 years, the patient is disease-free with the implant . This report illustrates the proof-of-concept of adjuvant skin-sparing ECT to sterilize resection margins, preserve a breast implant and highlight procedural details to avert toxicity.
一名55岁女性，曾因多灶性导管癌接受保留皮肤的乳房切除术及假体重建，现出现同侧腋窝复发。在进行淋巴结清扫、部分假体周围包膜切除术及切除覆盖的乳房皮肤后，病理报告显示切缘皮肤阳性。由于进一步切除乳房皮肤或放疗会影响假体植入，且患者坚决避免任何危及假体的干预措施，多学科建议在多模式治疗策略框架内采用针对皮肤的电化学疗法（ECT）。该手术在轻度全身镇静下持续了20分钟，包括静脉注射博来霉素推注，随后使用针电极局部施加电脉冲。术后过程顺利，仅出现轻度皮肤毒性。5年后，患者假体植入部位无疾病复发。本报告阐述了辅助性保留皮肤ECT用于消毒切除边缘、保留乳房假体的概念验证，并强调了避免毒性的手术细节。
