背景:乳腺癌现已成为女性癌症相关死亡的主要原因。在传统的根治术中,可能会出现并发症,可能会影响乳房的生理特征,并随后对患者造成深刻的心理压力。因此,背阔肌(LD)皮瓣重建为接受乳房切除术的患者提供了一种美学方法。目的是最大限度地提高皮瓣的软组织覆盖率,同时最大限度地减少供体部位的缺损和并发症。
方法:在普外科进行了一项前瞻性观察研究,Safdarjung医院,新德里,印度,纳入30例乳腺癌患者,并接受了乳房切除术并立即进行LD皮瓣重建。从术后第一天开始,术后以不同的时间间隔使用BREAST-Q问卷进行美容评估,第二周,和第六周。主观评估是由患者完成的,而一名失明的护士和外科医生进行了客观评估。
结果:大多数(n=23,76.7%)年龄在31-50岁之间。术后初始BREAST-Q评分下降,但到第六周显著改善,归因于伤口随着时间的推移逐渐愈合,导致改善乳房的形状和轮廓。与术后两周相比,失明的外科医生和护士在六周进行的客观评分有所改善。在术前和术后6周评分之间观察到几乎相似的结果,显著的总体p值<0.001。在客观评分方面,盲目的外科医生和护士之间没有显着统计学差异。
结论:年轻人口统计学中乳腺癌的上升趋势强调了平衡美容满意度和肿瘤预后的重要性。立即LD皮瓣乳房重建为进行乳房切除术的患者提供了一种可靠的软组织覆盖方法,并具有可接受的围手术期发病率。并发症发生率是可以接受的,供体部位血清肿,手术部位感染(SSI),和他们的肩膀软弱。它们可以被预防或处理(延长原位排水,缝缝线,和血清肿抽吸)或随时间解决(SSI和肩功能)。
BACKGROUND: Breast Cancer has now become the leading cause of cancer-related deaths among women. In a traditional radical mastectomy, there can be complications that may affect the physiological characteristics of the breast and subsequently cause profound psychological stress to the patients. Hence, latissimus dorsi (LD) flap reconstruction provides an aesthetic approach in patients undergoing mastectomy. The goal is to maximize the flap\'s soft tissue coverage while minimizing the magnitude of donor site defect and complication.
METHODS: A prospective observational study was conducted in the Department of General Surgery, Safdarjung Hospital, New Delhi, India, where 30 breast cancer patients were enrolled and had undergone mastectomy with immediate LD flap reconstruction. Cosmetic assessments using BREAST-Q questionnaires were conducted postoperatively at various intervals starting from postoperative day one, week two, and week six. The subjective evaluation was done by the patient, while a blinded nurse and surgeon did the objective assessment.
RESULTS: The majority (n=23, 76.7%) were aged 31-50 years. Initial postoperative BREAST-Q scores declined but significantly improved by week six, attributed to gradual wound healing over time, resulting in improved breast shape and contour. The objective scoring done by the blinded surgeon and nurse improved at six weeks compared to two weeks postoperatively. Almost similar outcomes were observed between preoperative and six-week postoperative scores with a significant overall p-value of <0.001. No significant statistical differences were noted between blinded surgeons and nurses for objective scoring.
CONCLUSIONS: The rising trend of breast cancer in younger demographics emphasizes the importance of balancing cosmetic satisfaction with oncological outcomes. Immediate LD flap breast reconstruction provides a reliable means for soft tissue coverage with acceptable perioperative morbidities for patients undergoing mastectomy. Complication rates were acceptable, with donor site seroma, surgical site infection (SSI), and shoulder weakness among them. They could be prevented or treated (prolonged drain in situ, quilting sutures, and seroma aspiration) or resolved with time (SSI and shoulder function).