scholarly journals Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect

2021 ◽  
Vol 54 (02) ◽  
pp. 208-210
Author(s):  
Dushyant Jaiswal ◽  
Mayur Raman Mantri ◽  
Vinay Kant Shankhdhar ◽  
Snehjeet Hemant Wagh
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Radical Mastectomy ◽  
Phyllodes Tumor ◽  
Left Breast ◽  
Skin Defect ◽  
Postoperative Radiation Therapy ◽  
Internal Mammary ◽  
Skin Excision ◽  
Large Skin

AbstractA 17-year-old girl with large malignant phyllodes tumor of left breast underwent a radical mastectomy with large skin excision resulting in defect of 20 cm × 18 cm. Postoperative radiation therapy necessitated robust cover with flap. The challenge was compounded by her body habitus. Both abdomen and back were deficient as donor sites and a single-island anterolateral thigh (ALT) flap would need skin grafts, volume deficit withstanding. We harvested chimeric ALT plus tensor fascia lata (TFL) perforator free flap sparing all muscles and nerves. Microvascular anastomoses were done to the second internal mammary artery (IMA) perforator artery and vein. The donor site was closed primarily. The TFL flap territory recruited almost three times the volume of ALT territory and allowed us to create a matching breast mound in addition to covering the defect. She tolerated 40 Gy radiation well and doesn’t desire further augmentation. Consistency of ALT and TFL perforators makes this a replicable procedure.

Using KISS Flaps in a Chest Wall Reconstruction After Mastectomy for Locally Advanced Breast Cancer: A New Technique

2019 ◽  
Vol 27 (1) ◽  
pp. 5-10
Author(s):  
Jia Song ◽  
Yong Han ◽  
Jian Liu ◽  
Kai Cheng ◽  
Qiang Gao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Primary Closure ◽  
Locally Advanced Breast Cancer ◽  
Skin Flap ◽  
Donor Site ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Advanced Breast ◽  
Skin Defect

This study described a technique for the reconstruction of large lateral thoracic defects after local advanced breast cancer resection that allows for complete cover of the defect and primary closure of the donor site. The authors performed reconstruction using the newly designed KISS flap in 2 women for coverage of their large skin defect (15 × 13 cm each) following mastectomies with extensive tissue resection. The KISS flap consisting of 2 skin islands (marked Flap A and Flap B; 15 × 6 cm each) was designed and transferred to the thoracic defect through the subcutaneous tunnel, and based on the same vessel. The flap covered properly without causing excessive tension and allowed primary closure of chest wound and donor defect. The security it brings is comparable with that of classical radical mastectomy, and its success rate is similar to that of single skin flap transplantation. Compared with the conventional pedicled latissimus-dorsi-musculocutaneous flap, we believe that the donor zone tension decreases, wherein the KISS flaps can reduce the incidence of incision dehiscence and nonhealing complications to some extent. The study reported good results from this technique and discussed the techniques that referenced previous reports.

Aggressive malignant phyllodes tumor of breast with omental metastases – A case report

2021 ◽  
Vol 40 (4) ◽  
pp. 287-291
Author(s):  
B. Rajkrishna ◽  
Rajesh Balakrishnan ◽  
Mithun Raam ◽  
A. Santhosh Raj ◽  
Patricia Sebastian ◽  
...  
Keyword(s):  
Radical Mastectomy ◽  
Phyllodes Tumor ◽  
Distant Metastases ◽  
Left Breast ◽  
Adjuvant Radiation ◽  
Left Chest ◽  
Dismal Prognosis ◽  
Phyllodes Tumour ◽  
Flap Cover ◽  
Malignant Phyllodes Tumour

Distant metastasis from malignant Phyllodes tumour (PT) is rare. They generally metastasize to the lung, bone, pleura, and liver. We present a very rare case of a 25-year-old woman with intraabdominal metastases from malignant phyllodes tumour of the breast. She presented with left breast lump and the biopsy was Phyllodes tumour. She underwent a two staged surgery; left modified radical mastectomy followed by left latissimus dorsi musculocutaneous flap cover. She received adjuvant radiation therapy to left chest wall. Following which she developed intrabdominal mass which was proven to be metastasis from Phyllodes tumour. She was then advised palliative chemotherapy. Malignant Phyllodes with distant metastases has a dismal prognosis. We propose it is preferable to have a CT Thorax and Abdomen as a staging workup for patients with malignant PT to identify those with poor prognosis.

scholarly journals CASE REPORT: METASTATIC PHYLLODE TUMOR

2020 ◽  
Vol 8 (10) ◽  
pp. 989-992
Author(s):  
E. Lemrabott ◽  
◽  
N. Abdelkader ◽  
A. Cheikh ◽  
N. Mamouni ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Phyllodes Tumor ◽  
Left Breast ◽  
Split Thickness Skin Graft ◽  
Axillary Lymph ◽  
Skin Defect ◽  
X Ray ◽  
Phyllodes Tumors ◽  
Standard Treatment Guidelines ◽  
The Right

Rationale: Malignant phyllodes tumors are rare breast neoplasms that are associated with a 6.2% to 25% incidence rate of distant metastasis the lung is the most common metastatic site. To date, there is no consensus regarding the treatment of metastatic malignant phyllodes breast tumors. Patient concern: A 34-year-old woman was admitted into the gynecology department for a rapidly growing left breast tumor that was first noticed month prior. Diagnosis: Core needle biopsy revealed a malignant phyllodes tumor. A chest computed tomography tomography/CT showed metastatic lymph nodes that appeared to have spread to the right axilla She was subsequently followed by course of radiotherapy, she consulted again 3 months later for a productive cough, X-ray thorax in comparison with that made preoperatively: presence of the left peri-hilar nodules which were not present on the first X-ray Interventions: A left mastectomy with axillary lymph node dissection was conducted and a thoracoabdominal flap and a split thickness skin graft were performed for the skin defect. And radiotherapie adjuvant. Lessons: As standard treatment guidelines for metastatic malignant phyllodes tumors are lacking, we opted for the aforementioned aggressive treatments that resulted in complete remission of the lung metastasis. Therefore, aggressive treatment, whenever possible, is warranted.

scholarly journals Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

2020 ◽  
Author(s):  
Jiqiang He ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Free Flaps ◽  
Lower Limbs ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Reliable Methods ◽  
Large Skin

Abstract Background: Extended latissimus dorsi musculocutaneous (LDMC) flap increasing the size of the flap and most used for breast reconstruction. This report will share our experience in designing different extended LDMC flap for large wounds in extremities.Patients and methods: From January 2004 to December 2018, extended LDMC flaps were performed on 72 consecutive patients aged 2 to 68 years (37 men and 35 women). All the wounds were extensive, either in upper or lower limbs, the skin defect ranged from 18 ×10 cm2 to 37 × 21 cm2. Single wing and double wings extended LDMC flaps were designed and harvested based on the wounds.Results: Seventy-two patients included this series, 5 pedicle and 67 free flaps were successfully harvested. The mean flap harvest time was 56.2 min. The donor sites were closed primarily in all patients. The venous compromise was noticed on the first postoperative day in 4 cases. Two flaps were salvaged after emergency re-exploration, another two patient’s flaps were total necrosis. One of the patients was received lower extremity amputation, another patient was repaired by extended LDMC flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients lost follow-up, the follow-up period ranged from 10 to 56 months (mean, 15.7 months). Patients didn’t occur significant donor site morbidities that influenced their daily activities during follow-up.Conclusion: The single wing and double wings extended latissimus dorsi musculocutaneous flaps are simple and reliable methods for large skin and soft-tissue defects in extremities.

Rhomboid Perforator Flap for a Large Skin Defect Due to Lumbosacral Meningocele

2005 ◽  
Vol 54 (6) ◽  
pp. 670-672 ◽  
Author(s):  
Gan Muneuchi ◽  
Yoshihito Matsumoto ◽  
Motoki Tamai ◽  
Tetsukuni Kogure ◽  
Hiroharu H. Igawa ◽  
...  
Keyword(s):  
Perforator Flap ◽  
Skin Defect ◽  
Large Skin

scholarly journals Reconstruction of a soft tissue defect of the thumb using a modified dorsal metacarpal artery flap: A case report study

2021 ◽  
Vol 3 (2) ◽  
pp. 107-112
Author(s):  
Christos Konstantinidis ◽  
Christos Kotsias ◽  
Dimitrios Giotis ◽  
Vasileios Panagiotopoulos ◽  
Konstantinos Konidaris ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Donor Site ◽  
Perforator Flap ◽  
Skin Incision ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Soft Tissue Defects ◽  
Dorsal Metacarpal Artery ◽  
Tissue Defects

Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the index finger with a second DMA perforator flap. 3 months postoperatively, patient’s satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

scholarly journals Case Report: Revisiting the Internal Mammary Artery Perforator Flap: Salvage Option for Circumferential Pharyngo-Esophageal Defects

2021 ◽  
Vol 8 ◽  
Author(s):  
Nicholas Marsden ◽  
Lipi Shukla ◽  
Damien Grinsell
Keyword(s):  
Case Report ◽  
Internal Mammary Artery ◽  
Donor Site ◽  
Perforator Flap ◽  
Oral Intake ◽  
Free Tissue Transfer ◽  
Internal Mammary ◽  
Free Closure ◽  
Artery Perforator

Patients that present with pharyngeal strictures and pharyngocutaneous fistulas in the context of previous reconstruction and post-operative radiotherapy often report significant morbidity and reduction in quality of life. Reconstruction of such defects present a substantial clinical challenge requiring the importation of unirradiated vascularized tissue to facilitate healing in a friable, fibrotic, and vessel depleted tissue bed. The authors present a case report demonstrating an adaptation of the internal mammary artery perforator (IMAP) flap for reliable reconstruction of circumferential pharyngeal defects with primary tension free closure of the donor site. This technique avoids the use of free tissue transfer in a hostile, irradiated neck. The tubed IMAP flap is an excellent option, serving the purposes of reconstruction as well as addressing the patient's presenting issues of a chronic sinus and pharyngeal stricture inhibiting oral intake.

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

2021 ◽  
Author(s):  
Yuwei Luo ◽  
Chang Zou ◽  
Jintao Hu ◽  
Pan Zhao ◽  
Yayuan Zhang ◽  
...  
Keyword(s):  
Phyllodes Tumor ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Surgical Margins ◽  
Skin Defect ◽  
Case Presentation ◽  
Malignant Phyllodes Tumor ◽  
Phyllodes Tumors ◽  
Large Skin

Abstract Background: Malignant phyllodes tumors of the breast are fairly rare and fast-growing tumors. They do not respond to chemotherapy or hormonal therapy except in malignant phyllodes tumors. Therefore, the primary treatment for malignant phyllodes tumors is wide surgical excision. Case presentation: Herein, we report a case study which featured a 26-year-old woman presented with a giant malignant phyllodes tumor measuring 20 × 17 × 13 cm. In order to reduce the chance of local recurrence, treatment for these types of tumors usually involves extensive excision with at least 1 cm of surgical margins. The patient underwent extended lumpectomy with 1-3 cm surgical margins, which left a large skin defect of 25 × 15 cm. Repair of such a large skin defect is a challenge to breast surgeons. This is the first reported case in which a “kiss” flap was successfully used to repair the skin defect created after resection of a giant malignant phyllodes tumor.Conclusions: The kiss flap could be considered as an effective method to repair large chest wall defects after resection of giant phyllodes tumors.

scholarly journals Bilateral Phyllodes Giant Tumor. A Case Report Analyzed by Array-CGH

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 825
Author(s):  
Francesco Fortarezza ◽  
Federica Pezzuto ◽  
Gerardo Cazzato ◽  
Clelia Punzo ◽  
Antonio d’Amati ◽  
...  
Keyword(s):  
Array Cgh ◽  
Phyllodes Tumor ◽  
Molecular Classification ◽  
Left Breast ◽  
Comparative Genomic ◽  
Fish Analysis ◽  
Molecular Tests ◽  
Giant Tumor ◽  
Metastatic Risk ◽  
The Right

The breast phyllodes tumor is a biphasic tumor that accounts for less than of 1% of all breast neoplasms. It is classified as benign, borderline, or malignant, and can mimic benign masses. Some recurrent alterations have been identified. However, a precise molecular classification of these tumors has not yet been established. Herein, we describe a case of a 43-year-old woman that was admitted to the emergency room for a significant bleeding from the breast skin. A voluminous ulcerative mass of the left breast and multiple nodules with micro-calcifications on the right side were detected at a physical examination. A left total mastectomy and a nodulectomy of the right breast was performed. The histological diagnosis of the surgical specimens reported a bilateral giant phyllodes tumor, showing malignant features on the left and borderline characteristics associated with a fibroadenoma on the right. A further molecular analysis was carried out by an array-Comparative Genomic Hybridization (CGH) to characterize copy-number alterations. Many losses were detected in the malignant mass, involving several tumor suppressor genes. These findings could explain the malignant growth and the metastatic risk. In our study, genomic profiling by an array-CGH revealed a greater chromosomal instability in the borderline mass (40 total defects) than in the malignant (19 total defects) giant phyllodes tumor, reflecting the tumor heterogeneity. Should our results be confirmed with more sensitive and specific molecular tests (DNA sequencing and FISH analysis), they could allow a better selection of patients with adverse pathological features, thus optimizing and improving patient’s management.

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