Early venous congestion after diep flap breast reconstruction: case report of a successful management.

Alessio Baccarani, Marta Starnoni, Marco Pappalardo, Melba Lattanzi, Claudio Gio Francesco Blessent, Federico De Maria, Giorgio De Santis
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Abstract

Background and aim: More than 250 000 women estimated to be diagnosed with breast cancer in the USA every year. Mastectomy is primary treatment for more than a third of those with early-stage disease. Most of the patients undergoing mastectomy receive breast reconstruction. A number of. Surgical techniques have been described to reconstruct the breast. With autologous tissue breast reconstruction, the plastic surgeon uses patient's own tissues, taken from a different part of the body where there is an excess of fat and skin. Deep inferior epigastric perforator (DIEP) flap is the autologous breast reconstruction technique of choice in our department due to long lasting results, low donor site morbidity and positive patient reported outcomes have been described.   Case Report: We present the case of a 42-year-old woman who underwent neoadjuvant chemotherapy followed by left breast simple mastectomy, axillary lymph-nodes dissection and later adjuvant radiation therapy (RT). After conclusion of RT a DIEP flap breast reconstruction was performed. Nine-hours after the operation, signs of acute venous congestion were noted. The venous congestion was treated by a combined surgical and medical approach based on pedicle discharge and ICU resuscitation protocol. After take back surgery, the patient was tightly monitored in the intensive care unit where intravenous heparin infusion and leech therapy were performed for 2 days. Flap congestion resolved completely, and the patient was discharged.   Conclusions: Venous congestion is very difficult to treat due to its potential multifactorial nature. The most important step is to recognize this kind of emergency because irreversible microvascular damages will develop in 6-8 hours. Because of multiple causes of venous congestion a timely multidisciplinary approach is mandatory, to maximize flap salvage and success rates.

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蝶形皮瓣乳房重建术后早期静脉充血:一例成功治疗的病例报告。
背景和目的:据估计,美国每年有超过25万名女性被诊断为癌症。乳房切除术是超过三分之一的早期疾病患者的主要治疗方法。大多数接受乳房切除术的患者接受乳房重建。许多。已经描述了重建乳房的外科技术。通过自体组织乳房重建,整形外科医生使用患者自己的组织,这些组织取自身体脂肪和皮肤过多的不同部位。上腹部深下穿通(DIEP)皮瓣是我科首选的自体乳房重建技术,因为其效果持久,供区发病率低,患者报告的结果呈阳性。病例报告:我们报告了一例42岁的女性,她接受了新辅助化疗,随后进行了左乳简单乳房切除术、腋窝淋巴结清扫和随后的辅助放射治疗(RT)。RT结束后,进行DIEP皮瓣乳房重建。术后9小时,观察到急性静脉充血的迹象。静脉充血采用基于椎弓根出院和ICU复苏方案的外科和医学联合方法进行治疗。收回手术后,患者在重症监护室接受严密监护,在那里进行了为期2天的静脉肝素输注和水蛭治疗。皮瓣充血完全缓解,患者出院。结论:静脉充血由于其潜在的多因素性质,很难治疗。最重要的一步是认识到这种紧急情况,因为不可逆的微血管损伤将在6-8小时内发展。由于静脉充血的多种原因,必须采用及时的多学科方法,以最大限度地提高皮瓣的挽救率和成功率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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