Pedro Ciudad1,2, Oscar J Manrique3,4, Samyd S Bustos3,4, Maria I Vargas1, César Reynaga1, Mouchammed Agko5, Tony C T Huang3, Eduardo Figueroa Benites6, Horacio F Mayer7, Antonio J Forte8. 1. Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru. 2. Department of Plastic and Reconstructive Surgery, Ciruesthetic Clinic, Lima, Peru. 3. Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA. 4. Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA. 5. Section of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA. 6. Department of Oncology, Arzobispo Loayza National Hospital, Lima, Peru. 7. Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Buenos Aires, Argentina. 8. Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL, USA.
Abstract
BACKGROUND: The combination of microvascular breast reconstruction (MBR) and vascularized lymph node transfer (VLNT) in a single-stage procedure is a surgical option for women who desire breast reconstruction and postmastectomy lymphedema surgery. In this study, we present a series of patients who underwent simultaneous lymphatic and MBR with the gastroepiploic VLNT (GE-VLNT) and the deep inferior epigastric perforator (DIEP) flap respectively. METHODS: Between 2018 and 2019, all consecutive patients diagnosed with lymphedema stage IIb-III International Society of Lymphology who opted to pursue simultaneous MBR with DIEP flap and GE-VLNT were included in this study. Patient demographics, comorbidities, prior radiation therapy, operative characteristics, surgical outcomes and complications were collected and analyzed. RESULTS: Six patients underwent simultaneous unilateral MBR with DIEP flap and GE-VLNT. The mean age was 48±10.5 years and mean body mass index was 28.2±4.5 kg/m2. The flap survival rate was 100%. One patient required re-exploration due to venous congestion of the lymph node flap but was successfully salvaged. There was no donor site morbidity at the donor or recipient site for the DIEP flap were seen. The mean circumference reduction rate was 30.0%±5.1% (P<0.001). One patient stage III underwent additional liposuction at 12 months postoperative to improve final results. CONCLUSIONS: The combined use of DIEP flap and GE-VLNT flaps in a single-stage procedure is a safe and reliable surgical option for patients with postmastectomy lymphedema who desire and are suitable for autologous microvascular breast and lymphatic reconstruction. 2020 Gland Surgery. All rights reserved.
BACKGROUND: The combination of microvascular breast reconstruction (MBR) and vascularized lymph node transfer (VLNT) in a single-stage procedure is a surgical option for women who desire breast reconstruction and postmastectomy lymphedema surgery. In this study, we present a series of patients who underwent simultaneous lymphatic and MBR with the gastroepiploic VLNT (GE-VLNT) and the deep inferior epigastric perforator (DIEP) flap respectively. METHODS: Between 2018 and 2019, all consecutive patients diagnosed with lymphedema stage IIb-III International Society of Lymphology who opted to pursue simultaneous MBR with DIEP flap and GE-VLNT were included in this study. Patient demographics, comorbidities, prior radiation therapy, operative characteristics, surgical outcomes and complications were collected and analyzed. RESULTS: Six patients underwent simultaneous unilateral MBR with DIEP flap and GE-VLNT. The mean age was 48±10.5 years and mean body mass index was 28.2±4.5 kg/m2. The flap survival rate was 100%. One patient required re-exploration due to venous congestion of the lymph node flap but was successfully salvaged. There was no donor site morbidity at the donor or recipient site for the DIEP flap were seen. The mean circumference reduction rate was 30.0%±5.1% (P<0.001). One patient stage III underwent additional liposuction at 12 months postoperative to improve final results. CONCLUSIONS: The combined use of DIEP flap and GE-VLNT flaps in a single-stage procedure is a safe and reliable surgical option for patients with postmastectomy lymphedema who desire and are suitable for autologous microvascular breast and lymphatic reconstruction. 2020 Gland Surgery. All rights reserved.
Entities:
Keywords:
Lymphedema; breast reconstruction and lymph node transfer; deep inferior epigastric perforator flap and lymph node transfer (DIEP flap and lymph node transfer); gastroepiploic lymph node transfer; vascularized lymph node transfer (VLNT)
Authors: Katelyn G Bennett; Ji Qi; Hyungjin M Kim; Jennifer B Hamill; Andrea L Pusic; Edwin G Wilkins Journal: JAMA Surg Date: 2018-10-01 Impact factor: 14.766