Fallah Kasra N, Ahmed Shahnur, Venardi Andrew S, Hulsman Luci A, Fisher Carla S, Ludwig Kandice K, Lester Mary E, Hassanein Aladdin H
From the Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Ind.
Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Ind.
Plast Reconstr Surg Glob Open. 2024 Sep 12;12(9):e6166. doi: 10.1097/GOX.0000000000006166. eCollection 2024 Sep.
Breast cancer-related lymphedema is characterized by progressive limb enlargement and occurs in up to 30% of breast cancer patients following axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) is a preventative technique used to reduce lymphedema rates by performing lymphovenous anastomoses of disrupted afferent lymphatics. This study presents a novel method of axillary reconstruction following ALND using a buried dermal flap that provides local tissue with intact subdermal lymphatics to the axillary dead space. A single-center retrospective review was performed to assess breast cancer patients who underwent modified radical mastectomy without reconstruction between 2018 and 2023. Groups were divided into those who had ILR alone (group 1) and those who had buried dermal flap with attempted ILR (group 2). There were 31 patients included in this study: 18 patients in group 1 and 13 patients in group 2. Patient demographics, comorbidities, and breast cancer history were similar between the groups. There was no significant difference in the mean number of lymphovenous anastomoses performed (1.6 versus 1.7, = 0.84). Mean operative time of 224.4 ± 51.9 minutes in group 1 was similar to 223.4 ± 30.4 minutes in group 2 ( = 0.95). We introduce a novel method of axillary reconstruction following ALND using a buried dermal flap that is inset into the axillary dissection space and over the area of ILR. We propose that it is an efficient accessory procedure to augment ILR by providing supplementary intact lymphatic channels to the area of lymphatic injury, while obliterating the axillary dead space.
乳腺癌相关淋巴水肿的特征是肢体逐渐肿大，在高达30%的乳腺癌患者腋窝淋巴结清扫术（ALND）后出现。即时淋巴管重建（ILR）是一种预防性技术，通过对中断的输入淋巴管进行淋巴静脉吻合来降低淋巴水肿发生率。本研究提出了一种ALND后腋窝重建的新方法，即使用带蒂真皮瓣，该瓣为腋窝死腔提供带有完整皮下淋巴管的局部组织。进行了一项单中心回顾性研究，以评估2018年至2023年间接受改良根治性乳房切除术且未进行重建的乳腺癌患者。将患者分为单纯接受ILR的组（第1组）和接受带蒂真皮瓣并尝试进行ILR的组（第2组）。本研究共纳入31例患者：第1组18例，第2组13例。两组患者的人口统计学特征、合并症和乳腺癌病史相似。两组进行的淋巴静脉吻合平均数量无显著差异（1.6对1.7，P = 0.84）。第1组的平均手术时间为224.4±51.9分钟，与第2组的223.4±30.4分钟相似（P = 0.95）。我们介绍了一种ALND后腋窝重建的新方法，即使用带蒂真皮瓣，将其嵌入腋窝清扫空间并覆盖在ILR区域上方。我们认为，这是一种有效的辅助手术，通过为淋巴损伤区域提供额外的完整淋巴通道来增强ILR，同时消除腋窝死腔。
