Radiation-induced cutaneous vasculopathy of the breast: a rare case report.

BACKGROUND: Radiation therapy is often indicated as part of the treatment for breast cancer and is therefore used frequently worldwide. Vasculopathy is a general term used to describe any condition that affects blood vessels. We present a case report of a patient who presented with vasculopathy as a rare late side effect of radiation therapy to the breast. CASE PRESENTATION: This 66-year-old woman was initially treated with breast-conserving surgery for early-stage receptor-positive left breast carcinoma. She received postoperative radiation therapy and hormonal treatment with tamoxifen. She developed sudden spontaneous painless ecchymosis spread over the whole irradiated area 1.5 years after finishing her radiation therapy. Tumor relapse was excluded. There was no associated vasculitis. The cause was presumed to be multifactorial. She had a history of smoking and was known to have hyperlipidemia. She had undergone several surgical treatments at the left breast one year after her initial breast-conserving treatment and was taking tamoxifen. Anti-inflammatory medicine and treatments increasing local blood flow were prescribed. The ecchymosis resolved completely within one month. CONCLUSIONS: Vasculopathy can occur as a rare late side effect of radiation therapy. It can be reversible. Prevention begins with carefully treating precipitating factors.

The effect of various muscle transfer procedures on eye closure and blinking in longstanding facial palsy patients.

BACKGROUND: Facial palsy causes paralytic lagophthalmos, which remarkably deteriorates a patient's quality of life. In cases where denervation time is over 18-24 months (longstanding facial palsy), a free or pedicled muscle transfer is needed to replace the denervated orbicularis oculi muscle. PURPOSE: The purpose of this systematic review is to investigate the effect of various eye sphincter substitution procedures (free or pedicled muscle transfers) in longstanding facial palsy patients on eye closure and blink. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review of the Embase, Medline, Web of Science and Cochrane Library databases and Google Scholar. Our literature search yielded 4322 articles. Following a full-text review, 4 retrospective cohort studies and 21 case series were selected for this review. Meta-analyses using R package meta (version 6.5-0) were conducted. MAIN FINDINGS: All free and pedicled muscle transfers in this review showed an improvement in the scores and measurements on eye closure and blink. The pedicled temporalis muscle transfer was the procedure most commonly performed as eye reanimation surgery and showed consistent good results. Using the random effects model, the pooled effect of mean difference in lagophthalmos after gentle eye closure post-operatively versus pre-operatively (mm) in patients who received a pedicled (temporalis) muscle transfer was -6.19 (I2 = 85%, 95% CI: -7.89; -4.49) whereas it was -4.11 (I2 = 85%, 95% CI: -7.26; -0.95) for free (gracilis or platysma) muscle transfers. The pooled proportion of patients with complete eye closure after surgery was 0.69 (I2 = 49%, 95% CI: 0.54; 0.82) in patients who received a pedicled (temporalis) muscle transfer and 0.40 (I2 = 74%, 95% CI: 0.13; 0.74) in patients who received a free (platysma) muscle transfer. CONCLUSIONS: Unlike smile reanimation, dynamic eye closure and blink restoration are rather neglected topics in facial reanimation. The pedicled temporalis muscle transfer is often recommended as the first treatment of choice for eye reanimation in longstanding facial palsy patients since it is a reliable, straightforward procedure, that does not require complex microsurgery. However, with the advancements in the field of microsurgery, free muscle transfers are promising therapies, which may regenerate voluntary and spontaneous blinking.

The evolution of breast reconstructions with free flaps: a historical overview.

BACKGROUND: Breast cancer is the most frequent cancer among women and is responsible for the highest number of cancer-related deaths. Approximately 40% of the patients with breast cancer will undergo a mastectomy. Breast amputation is a lifesaving but mutilating procedure. Therefore a good quality of life and a good cosmetic outcome is mandatory after breast cancer treatment. Reconstructive breast surgery aims to recreate a natural looking breast that is warm, soft and feels natural. The chosen reconstruction technique depends on the physiognomy of the patient, technical skills of the surgeon and most important the expectations of the patient. RESULTS: The idea of 'like-by-like' replacement refers to reconstruction of a natural-looking, warm, soft and ptotic breast that matches the contralateral side. Autologous breast-reconstruction matches these expectations. Autologous breast reconstructions with free flaps evolved from prolonged and laborious procedures with only limited free flaps available, to routine surgeries with a widespread availability of flaps to use. The first publication of free tissue transfer for breast reconstruction was in 1976 by Fujino. Two years later Holmström was the first to use the abdominal pannus for breast reconstruction. Over the next four decades multiple free flaps have been described. The possible options for donor site are the abdomen, the gluteal region, the thigh and the lower back. During this evolution the reduction of donor site morbidity became more important. CONCLUSION: Present article gives an overview of the evolution of free tissue transfer in breast reconstruction, highlighting the most important milestones.