RESUMO
The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Eleven studies amounting to 432 cases were reviewed and considered to be at high risk of bias due to small sample size, selective outcome reporting and selection bias. Heterogeneity due to lack of consensus of outcome measures prevented meaningful analysis. Fifty-two (12.3%) clinical complications were recorded: seroma (n = 9; 2.1%), fat necrosis (n = 9; 2.4%), haematoma (n = 8; 1.9%), infection (n = 9; 2.1%), and flap necrosis (n = 9; 2.1%). Thirty-four (10.8%) patients had an involved positive margin, 29 patients underwent re-excision (9.3%) and four underwent completion mastectomy (1.3%). One local recurrence and six distant recurrences were observed during a mean follow up of 21 months (1-49). A pooled patient cosmetic satisfaction descriptor of good or excellent was described in 93% of cases. CWPFs are a safe method of partial breast reconstruction following BCS. They are associated with a low complication rate, acceptable short-term oncological outcomes and satisfactory cosmetic outcome. There is a relative paucity in quality of data in this field and larger prospective studies are needed to investigate outcomes further.
Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia Segmentar/métodos , Recidiva Local de Neoplasia/epidemiologia , Satisfação do Paciente , Retalho Perfurante , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos , Parede Torácica/transplante , Neoplasias da Mama/patologia , Feminino , Hematoma/epidemiologia , Humanos , Margens de Excisão , Necrose/epidemiologia , Seroma/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do TratamentoRESUMO
Surgery of the chest wall is potentially required to cover large defects after removal of malignant tumours. Usually, inert and non-degradable Gore-Tex serves to replace the missing tissue. However, novel biodegradable materials combined with stem cells are available that stimulate the healing. Based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/aCaP) and pure PLGA, a dual layer biodegradable hybrid nanocomposite was generated. Mouse adipose-derived stem cells were cultered on electrospun disks (ASCs of C57BL/6), and biomechanical tests were performed. The cell-seeded scaffolds were engrafted in C57BL/LY5.1 mice to serve as a chest wall substitute. Cell invasion into the bi-layered material, extent of CD45+ cells, inflammatory response, neo-vascularization and ECM composition were determined at 1 and 2 months post-surgery, respectively. The bi-layered hybrid nanocomposite was stable after a 2-week in vitro culture, in contrast to PLGA/aCaP without a PLGA layer. There was a complete biointegration and good vascularization in vivo. The presence of ASCs attracted more CD45+ cells (hematopoietic origin) compared to cell-free scaffolds. Inflammatory reaction was similar for both groups (±ASCs) at 8 weeks. A bi-layered hybrid nanocomposite fabricated of electrospun PLGA/aCaP and a reinforcing layer of pristine PLGA is an ideal scaffold for chest wall reconstruction. It is stable and allows a proper host tissue integration. If ASCs are seeded, they attract more CD45+ cells, supporting the regeneration process.
Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Nanocompostos/uso terapêutico , Parede Torácica/transplante , Alicerces Teciduais , Transplantes/transplante , Animais , Fosfatos de Cálcio/uso terapêutico , Diferenciação Celular , Masculino , Células-Tronco Mesenquimais/citologia , Camundongos , Camundongos Endogâmicos C57BL , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/uso terapêutico , Engenharia Tecidual , CicatrizaçãoRESUMO
The supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015. No significant differences in mean complication rates were observed when the SCIF was used for primary or salvage reconstruction (28% versus 25%, respectively, pâ¯=â¯0.816) or for cutaneous or intraoral reconstruction (27% versus 28%, respectively, pâ¯=â¯0.932). Flap folding, preoperative radiotherapy, and microsurgery were associated with significantly increased complication rates (pâ¯=â¯0.002, pâ¯=â¯0.043, and pâ¯=â¯0.001, respectively), whereas smoking (pâ¯=â¯0.431) had no impact with regard to this. In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options.
Assuntos
Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Terapia de Salvação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cervicoplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/transplanteRESUMO
BACKGROUND: Women with small- to moderate-sized breasts present a specific challenge to performing oncoplastic volume-displacement techniques for reconstructing breast defects after breast-conserving surgery (BCS). In such cases, the lateral thoracic wall region serves as a versatile reconstruction donor site. Therefore, in the present study, we aimed to investigate the effectiveness and feasibility of employing lateral thoracic adipofascial (LTA) flaps to reconstruct breast defects following BCS. PATIENTS AND METHODS: A total of 58 female patients who underwent BCS between February 2016 and April 2017 were analyzed. Of these, 33 patients were reconstructed with LTA flaps, and the other 25 patients received BCS only and were assigned as the control group. All patients were followed up, and we assessed surgery-related complications, breast appearance, and disease recurrence. RESULTS: The mean weight of the resected breast tissue was 65.9 g (range, 35-100 g). The mean volume of LTA flaps was 309.5 cm3 (range, 112.6-588 cm3). This oncoplastic technique was performed with minimal complications in all patients. Two patients exhibited partial adipose liquefaction (6.1%), and 2 patients manifested wound infections. CONCLUSIONS: The LTA flaps were reliable and useful for reconstructing breast defects after BCS when the resected volume was confined to between 50 and 100 g, particularly in patients with small- to moderate-sized breasts. This is optimal for patients with lesions located in the upper-outer quadrant.
Assuntos
Tecido Adiposo/transplante , Neoplasias da Mama/cirurgia , Mama/cirurgia , Fáscia/transplante , Mamoplastia/métodos , Mastectomia Segmentar/métodos , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Mama/patologia , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Parede Torácica/transplanteRESUMO
Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cavity in order to abolish and avoid the complications associated with this dead space. Although effective in achieving this, the procedure is crippled by poor cosmetic appearance and functional outcome. We report a case of recalcitrant complex chest wall defect with a large cavity, marred by visible heart and poor availability of local muscles, that was successfully managed by a novel technique of thoracoplasty with acceptable postoperative appearance and function.
Assuntos
Retalhos Cirúrgicos/transplante , Ferida Cirúrgica/cirurgia , Parede Torácica/anormalidades , Parede Torácica/cirurgia , Toracoplastia/métodos , Adolescente , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa/métodos , Pneumonectomia/métodos , Complicações Pós-Operatórias , Período Pós-Operatório , Aspergilose Pulmonar/cirurgia , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Ferida Cirúrgica/complicações , Parede Torácica/patologia , Parede Torácica/transplante , Toracotomia/efeitos adversos , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Chest wall defect may be caused by many factors such as the resection of tumor and trauma, and the reconstruction of bone-defection is still the key point of thoracic surgery. With the development of material science, more and more new materials have been used in medical practice, which makes huge progress in the surgery of chest wall. However, none of these materials satisfy all the practical needs of the reconstruction. Recently, with the development of the capacity of computer, 3D-printing technology has been gradually used in clinical work, and the idea of individual treatment has been accepted by more and more people. The weakness of these materials may be solved by the new material and the application of individual treatment, which could also make great advance in chest wall surgery. This article will make a summary of the research on the reconstruction of chest wall.â©.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Animais , Materiais Biocompatíveis/síntese química , Materiais Biocompatíveis/química , Humanos , Impressão Tridimensional , Procedimentos de Cirurgia Plástica/instrumentação , Parede Torácica/transplanteRESUMO
Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression must be pursued. Employing vascularized bone marrow transplantation and co-transplantation of the thymus have shown promise in this regard in various animal models. Vascularized bone marrow transplantation allows for the uninterrupted transfer of donor bone marrow cells within the preserved donor microenvironment, and the incorporation of thymus tissue with vascularized bone marrow transplantation has shown to increase T-cell chimerism ultimately playing a supportive role in the induction of immune regulation. The combination of solid organ and vascularized composite allotransplantation can uniquely combine these strategies in the form of a novel transplant model. Murine models serve as an excellent paradigm to explore the mechanisms of acute and chronic rejection, chimerism, and tolerance induction, thus providing the foundation to propagate superior allograft survival strategies for larger animal models and future clinical application. Herein, we developed a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique. The experience in syngeneic and allogeneic transplant settings is described for future broader immunological investigations via an instructional manuscript and video supplement.
Assuntos
Transplante de Coração/métodos , Modelos Animais , Parede Torácica/transplante , Timo/transplante , Transplante Homólogo/métodos , Animais , Sobrevivência de Enxerto , CamundongosRESUMO
BACKGROUND: The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988 at our institution. We identified a new branch of the supraclavicular artery that nourishes the anterior chest, and on the basis of this finding, we created a new flap called the subclavicular flap. Unlike the supraclavicular flap, which is pedicled by the deltoid branch, this flap is primarily pedicled by the thoracic branch, and it shares similar vascular territory with the deltopectoral flap. In China, this flap has been widely used for neck reconstruction since our first publications on it in 1993. However, reports of its application are limited. To popularize the use of this flap, we present our experiences with pre-expanded subclavicular island flaps for the repair of facial scars. METHODS: Fifteen patients with facial scars underwent reconstruction with these flaps. All flaps underwent pre-expansion before being transferred to the face through a subcutaneous tunnel. The pivot point was in the supraclavicular region and allowed the flap to reach the mid-face without compulsive positioning. Donor sites were closed primarily. RESULTS: Flaps sizes ranged from 4 cm × 5 cm-10 cm × 17 cm. Fourteen flaps survived completely with satisfactory colour and texture. Total flap loss occurred in one patient, who was then treated by harvesting a skin graft from the dying flap. One patient experienced venous congestion, and the flap was successfully salvaged by pure vein anastomosis. CONCLUSION: Pre-expanded subclavicular island flaps have similar benefits to supraclavicular and deltopectoral flaps, and they may emerge as one of the best choices for cervicofacial reconstruction globally.
Assuntos
Cicatriz/cirurgia , Face/cirurgia , Procedimentos de Cirurgia Plástica , Transplante de Pele , Artéria Subclávia/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Parede Torácica/transplante , Adolescente , Adulto , Criança , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Expansão de Tecido/métodos , Sobrevivência de Tecidos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do TratamentoRESUMO
Radical treatment of parotid neoplasms may lead to complex parotid defects that present functional and aesthetic reconstructive challenges. We report our experience using the lateral thoracic wall as a single donor site. Between 2003 and 2009, four patients with malignant tumours in the parotid gland underwent radical parotidectomy and simultaneous reconstruction using a perforator latissimus dorsi cutaneous free flap (de-epithelialized and entire skin paddle in two cases each). A thoracodorsal nerve graft was used in all cases to replace the intraglandular branches of the facial nerve. Costal grafts were used for mandibular reconstruction in two patients. All patients underwent postoperative physiotherapy. No donor-site complication occurred and all treatments achieved good aesthetic results. All patients recovered nearly complete symmetry at rest and partial facial mimetic function. The lateral thoracic wall is a good donor site for the reconstruction of complex parotid defects.
Assuntos
Neoplasias Parotídeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Parede Torácica/transplante , Sítio Doador de Transplante/cirurgia , Idoso , Transplante Ósseo/métodos , Estética , Músculos Faciais/inervação , Músculos Faciais/fisiologia , Nervo Facial/cirurgia , Feminino , Seguimentos , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Reconstrução Mandibular/métodos , Músculo Esquelético/transplante , Esvaziamento Cervical , Nervos Periféricos/transplante , Modalidades de Fisioterapia , Costelas/transplante , Transplante de Pele/métodos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: To study the use of the lateral thoracic flap to repair a pectoralis major flap donor site defect when primary closure is not possible. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: All patients requiring pectoralis major flap reconstruction after tumour extirpation in the head and neck region, whose chest wall donor defects could not be closed primarily, were recruited to the study; lateral thoracic flaps were performed to close the wounds. RESULTS: Ten patients were recruited between July 2005 and November 2007. The patients were between 48 and 76 years of age. The lateral thoracic flap size ranged from 5 x 8 cm to 9 x 12 cm. All secondary donor sites in the lateral chest wall were closed primarily. There was no flap necrosis and the secondary donor sites healed without complications. CONCLUSION: The lateral thoracic flap is safe and reliable technique for reconstructing the chest wall donor defect from the pectoralis major flap when primary closure is not possible.