A comprehensive treatment algorithm for patients requiring simultaneous breast and lymphedema reconstruction based on lymph node transfer

D. Dionyssiou, E. Demiri
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引用次数: 4

Abstract

Background: Secondary upper limb lymphedema may progress in a deleterious condition that affects the quality of life of breast cancer survivors. Post-mastectomy patients, who also suffer from refractory lymphedema, often require a simultaneous breast reconstruction and lymphedema treatment. Autologous breast reconstruction, which remains the gold standard, can be combined with a free vascularized lymph node transfer to restore the impaired lymphatic circulation. Here we describe the algorithmic approach which is used in our department when managing post-mastectomy lymphedema patients, based on lymphedema stage, and body characteristics. Methods: We analyze the parameters that should be considered in order to select the appropriate breast-reconstruction method, including body characteristics, breast size, previous radiotherapy, availability of donor lymph nodes and characteristics of the lymphedematous affected limb. We also present our data on simultaneous breast and lymphedema reconstruction, during the period 2011–2020. Method for breast reconstruction, donor site of lymph node flap, number of lymph nodes contained into the flap, affected limb volume improvement and infection episodes, need for secondary operations at the breast or limb, postoperative complications and patients’ satisfaction level, are recorded and analyzed. Results: A total of 69 mastectomy and upper limb lymphedema patients were included in the study, 35 underwent partial breast reconstruction with local flaps or lipofilling, coupled with autologous lymph node transfer, while 34 underwent a combined procedure of lymphedema and total breast reconstruction (deep inferior epigastric perforator flaps n=24, fat-augmented latissimus dorsi flaps n=8, implants n=2). Inguinal lymph nodal flaps were used in all cases; a mean of 4.1 lymph nodes were contained in the flaps. The need for secondary surgeries was assessed as 1.4 per patient. A mean volume reduction of 54.8% between upper limbs was documented (52.9% for Stage I, 54.3% for Stage II and 61% for Stage III lymphedema) at the mean 4years and 8 months follow-up; mean infection episodes were reduced from 1.2 to 0.2 per patient. All patients confirmed their subjective satisfaction. Conclusions: Simultaneous breast and lymphedema reconstruction is an effective combined procedure for addressing both mastectomy and upper-limb lymphedema in a single operation. Given the complexity and technical requirements of these demanding surgeries, the use of algorithms may help reconstructive surgeons to make a systematic approach and appropriate planning of the procedure, in order to obtain better postoperative results.
一种基于淋巴结转移同时重建乳房和淋巴水肿患者的综合治疗算法
背景:继发性上肢淋巴水肿可能是一种有害的疾病,会影响癌症幸存者的生活质量。乳房切除术后的患者也患有难治性淋巴水肿,通常需要同时进行乳房重建和淋巴水肿治疗。自体乳房重建仍然是黄金标准,可以与游离血管化淋巴结转移相结合,以恢复受损的淋巴循环。在这里,我们描述了我们部门在管理乳房切除术后淋巴水肿患者时使用的算法方法,该方法基于淋巴水肿阶段和身体特征。方法:我们分析了选择合适的乳房重建方法时应考虑的参数,包括身体特征、乳房大小、既往放疗、供体淋巴结的可用性和淋巴水肿患肢的特征。我们还介绍了2011-2020年期间同时进行乳房和淋巴水肿重建的数据。记录并分析乳房重建的方法、淋巴结皮瓣的供区、皮瓣内淋巴结的数量、患肢体积的改善和感染情况、乳房或肢体二次手术的需要、术后并发症和患者的满意度。结果:本研究共纳入69例乳房切除术和上肢淋巴水肿患者,其中35例接受了局部皮瓣或脂肪填充的部分乳房重建,结合自体淋巴结转移,34例行淋巴水肿和全乳重建联合手术(上腹部下穿支皮瓣24例,背阔肌增脂皮瓣8例,植入物2例)。所有病例均采用腹股沟淋巴结皮瓣;皮瓣平均有4.1个淋巴结。二次手术的需求评估为每位患者1.4次。在平均4年零8个月的随访中,上肢之间的平均体积减少了54.8%(I期为52.9%,II期为54.3%,III期为61%);平均感染次数从每名患者1.2次减少到0.2次。所有患者都证实了他们的主观满意度。结论:乳腺和淋巴水肿同时重建是一种有效的联合手术,可在一次手术中同时解决乳房切除术和上肢淋巴水肿问题。考虑到这些高要求手术的复杂性和技术要求,算法的使用可能有助于重建外科医生对手术进行系统的方法和适当的规划,以获得更好的术后结果。
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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