Reconstruction of the chest wall in locally advanced breast cancer with multi-disciplinary cooperation: a case report of mesh repair plus TRAM combined with DIEP chest wall reconstruction
| Autor: | Weizhang Chen, Zhongzeng Liang, Zhu Liang, Baoying Chen, Yuanqi Zhang, Pu Qiu, Jianwen Li, Baoyi Huang, Kangwei Luo, Shengchao Huang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Breast surgery medicine.medical_treatment Perforation (oil well) Case Report 030206 dentistry medicine.disease Radiation therapy 03 medical and health sciences Inferior epigastric vein 0302 clinical medicine Breast cancer Thoracoacromial artery medicine.vein 030220 oncology & carcinogenesis medicine.artery medicine Surgery Radiology Axillary vein business Inferior epigastric artery |
| Zdroj: | Gland Surg |
| ISSN: | 2227-8575 2227-684X |
| DOI: | 10.21037/gs-20-436 |
| Popis: | Locally advanced breast cancer, which is defined as a malignant breast tumor that invades or adheres to the surrounding tissue, is characterized by the invasion of the chest wall and the skin surface by the tumor. Multiple lymph nodes are invaded and fuse into a mass, causing extensive axillary lymph node metastasis. However, locally advanced breast cancer does not exhibit distant metastasis. At present, in most hospitals in China and the rest of the world, this type of breast cancer is primarily managed through systematic and local treatments. However, a consensus concerning the optimal surgical method for chest wall reconstruction, which for many surgeons is a difficult and confusing procedure, has not been reached. In the past, many breast centers had used skin flap combined with hard mesh titanium alloy plate to repair the large chest wall defects. Although titanium alloy plate can maintain the stability of the chest wall, it may have a negative effect on the follow-up radiotherapy of breast cancer patients, which is a controversial method. In addition, titanium alloy mesh also has the risk of deformation and fracture. These factors will cause some hidden dangers to patient safety. According to the research, the soft mesh not only has the characteristics of satisfactory compatibility and robustness for maintaining the stability of chest wall, but also does not affect the postoperative radiotherapy of patients. Combined with the advantages of soft mesh, Our department treated a case of locally advanced breast cancer with chest wall invasion. Through cooperation between the breast surgery and thoracic surgery departments, a mesh repair plus transverse rectus abdominis myocutaneous (TRAM) combined with deep inferior epigastric perforator (DIEP) procedure was performed to remove the breast tumor and repair the large area of skin defect after surgery, and a relatively satisfactory therapeutic effect was achieved. In this case, we took two novel approaches: first, a 4-layer high-density polyethylene mesh was used to repair the defect; secondly, the inferior epigastric artery perforation was anastomosed with the thoracoacromial artery (end-to-end anastomosis) and the inferior epigastric vein perforation was anastomosed with the axillary vein (end-to-side anastomosis). |
| Databáze: | OpenAIRE |
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