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Single vertical incision thoracoabdominal flap for chest wall reconstruction following mastectomy of locally advanced breast cancer

Annals of Surgical Treatment and Research 2019년 97권 4호 p.168 ~ 175
 ( Min Kyung-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Plastic Surgery

 ( Choi Eun-Jeong ) - University of Ulsan College of Medicine Asan Medical Center Department of Plastic Surgery
 ( Lee Yeon-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Plastic Surgery
 ( Eom Jin-Sup ) - University of Ulsan College of Medicine Asan Medical Center Department of Plastic Surgery
 ( Son Byung-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Ahn Sei-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Kim Eun-Key ) - University of Ulsan College of Medicine Asan Medical Center Department of Plastic Surgery

Abstract


Purpose: Skin grafts have been widely used in managing extensive chest wall defects after mastectomy for advanced breast cancer. However, their durability and tolerability to radiotherapy is still controversial. A thoracoabdominal (TA) flap with a few technical refinements can safely transfer a larger flap while minimizing complications.

Methods: From January 2007 to February 2018, a retrospective review was performed to compare 2 groups after wide breast excision: skin graft group (group 1) and lateral-based, single vertical incision rotation-advancement TA flap (group 2). Patients' demographics, operative details, complications, hospital stay, postoperative outpatient visits, cost, and start of adjuvant therapy were analyzed between the 2 groups.

Results: During the study period, 34 patients received skin graft and 41 patients received TA flap. group 2 had a shorter hospital stay (6.41 ± 2.64 days vs. 12.62 ± 4.60 days, P < 0.001) and shorter time to complete wound healing (29.27 ± 18.68 days vs. 39.24 ± 27.70 days, P = 0.03) than group 1. There was also a difference in the period from surgery to initiation of adjuvant therapy (group 1, 45.04 days ± 17.79 days; group 2, 37.07 ± 15.38 days, P = 0.073). Although limitation in shoulder motion was more frequent in group 2, limitation of motion for >1 year was observed in 4 patients in only group 1 (43.90% vs. 38.24%, P = 0.613).

Conclusion: TA flap has a simple design that minimizes concerns involving the donor site. Moreover, it does not require complicated procedures and allows for re-elevation whenever necessary. Finally, it guarantees faster wound recovery than skin graft with fewer complications.

키워드

Breast neoplasms; Chest wall; Inflammatory breast neoplasms; Reconstructive surgical procedure; Surgical flaps
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