ObjectiveTo investigate the feasibility and effectiveness of a modified cross-lip flap with lip artery anatomosis so as to shorten inward time. MethodsBetween August 2010 and January 2014, 11 patients underwent cross-lip flap surgery with lip artery anatomosis to repair upper lip defects. There were 9 males and 2 females with an average age of 62 years (range, 13-70 years). The defects causes were tumors removal in 6 cases, animal bites in 2 cases, and secondary deformity after cleft lip repair surgery in 3 cases. The width and height of defect were 1.5-4.0 cm and 1.8- 3.5 cm respectively; the width and height of flap were 1.5-3.2 cm and 1.5-3.0 cm respectively. The donor site was directly sutured. ResultsAll flaps survived, and wound healed by first intention. The flap pedicle was cut off at 5 days after operation. No blister, desquamation, or circulatory malfunction was found. Delayed healing of incision occurred in 1 patient with diabetes. Eleven patients were followed up 5-24 months (mean, 11 months). The patients had normal facial expression, food intake, and language function. The function of brush directional stroke test sensation recovered in 7 (77.8%) of 9 followed patients at 12 months after operation. ConclusionThe modified cross-lip flap with lip artery anatomosis is feasible and effective in repair of upper lip defects, because it can gain much more blood supply from lip right now in first surgery, shorten inward time, and relief patient's discomfort.
ObjectiveTo investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. MethodsIndocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm×6 cm to 26 cm×12 cm. ResultsA total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis. ConclusionIntraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.
ObjectiveTo explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. MethodsBetween April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as TisN0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm. ResultsOne patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. ConclusionAdequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.
ObjectiveTo explore the techniques and short-term effectivness of contralateral breast symmetrization mammaplasty in breast reconstruction. MethodsBetween February 2014 and December 2015, 11 patients received immediate or delayed breast reconstruction after nipple-sparing mastectomy (6 and 5 cases respectively) for contralateral breast symmetrization mammaplasty. The age ranged 36-55 years (mean, 45 years). The disease duration was from 7 days to 6 months (mean, 2.5 months) in 6 patients undergoing immediate breast reconstruction. According to tumor TNM staging, 2 cases were rated as TisN0M0, 3 cases as T1N0M0, and 1 case as T2N0M0. The duration was from 2 to 25 years (mean, 8 years) in 5 patients undergoing delayed breast reconstruction. The implant (7 cases) and latissimus dorsi (4 cases) were used for breast reconstruction; and breast augmentation (6 cases) and breast reduction (5 cases) were performed for contralateral breast symmetrization. ResultsOne patient had local poor wound healing postoperatively and was cured; primary healing was obtained in the other patients, and no other postoperative complication of infection, implant exposure or capsular contracture was found. The patients were followed up 3 to 24 months (mean, 12 months). The reconstructive outcomes were excellent in 9 cases and good in 2 cases, with an excellent and good rate of 100%. There was no recurrence or metastasis. ConclusionSimultaneous contralateral symmetrization with augmentation/reduction mammaplasty after breast reconstruction can obtain satisfactory symmetric outcomes.