The preliminary application of 3-dimensional visual technique without eyepiece in repairing breast defect after radical mastectomy in 2 cases of breast cancer

Abstract

Objective To investigate the possibility of microsurgical anastomosis of artery, vein and lymphatic vessel under 3-dimension screen without eyepiece. Methods During March, 2019, 2 cases (48 and 62 years old) were operated for breast reconstruction, chest wall deformity modified, and axillary scar contracture release, under 3-dimension screen without eyepiece. Deep epigastric artery perforators (artery and vein) dissections were carried on, and microsurgical anastomosis of artery, vein and lymphatic vessel were finished. Coupler was used to do the end-to-end anastomosis of veins (2.5 mm), interrupted suture end-to-end anastomosis with 9-0 nylon for artery (2.0 mm). Reverse arm lymphatic dynamic fluorescence methylene blue tracer under Near Infrared Imaging was used to test the function of lymphatic system. The ends of 2 dominant drainage lymphatic vessels was found in the released axillary area (0.2 mm and 0.3 mm, respectively) , and were anastomosis to the vein (0.5 mm) of lateral chest lymphatic tissue. Immediate methylene blue tracer under near infrared imaging was used to confirm the patency of lymphatic vessels-veins anastomosis and follow-up post operation. Flap were monitored use HHD. Results Two patients recovered well, and the flaps survived completely with appreciated appearances. The lymphedema of the arms were getting better, the peripheral diameter was reduced by about 2.0 cm compared with that before operation. Conclusion The technique of microsurgical anastomosis of artery, vein and lymphatic vessel without eyepiece under 3-dimension screen is possible and safe. Key words: Three-dimensional visual technique vessel(3-dimension screen); Without eyepiece; Breast reconstruction; Lymphedema; Microvascular anastomosis; Lymphatic vessel anastomosis