Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study

Mastectomy skin flap necrosis (MSFN) and partial DIEP (deep inferior epigastric artery perforator) flap loss represent two frequently reported complications in immediate autologous breast reconstruction. These complications could be prevented when areas of insufficient tissue perfusion are detected intraoperatively. Hyperspectral imaging (HSI) is a relatively novel, non-invasive imaging technique, which could be used to objectively assess tissue perfusion through analysis of tissue oxygenation patterns (StO2%), near-infrared (NIR%), tissue hemoglobin (THI%), and tissue water (TWI%) perfusion indices. This prospective clinical pilot study aimed to evaluate the efficacy of HSI for tissue perfusion assessment and to identify a cut-off value for flap necrosis. Ten patients with a mean age of 55.4 years underwent immediate unilateral autologous breast reconstruction. Prior, during and up to 72 h after surgery, a total of 19 hyperspectral images per patient were acquired. MSFN was observed in 3 out of 10 patients. No DIEP flap necrosis was observed. In all MSFN cases, an increased THI% and decreased StO2%, NIR%, and TWI% were observed when compared to the vital group. StO2% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO2% (51% in the vital group versus 32% in the necrosis group, p < 0.0001) and a cut-off value of 36.29% for flap necrosis. HSI has the potential to accurately assess mastectomy skin flap perfusion and discriminate between vital and necrotic skin flap during the early postoperative period prior to clinical observation. Although the results should be confirmed in future studies, including DIEP flap necrosis specifically, these findings suggest that HSI can aid clinicians in postoperative mastectomy skin flap and DIEP flap monitoring.

Phalloplasty With a Free Scapular Flap Improves Postoperative Sensation in Penile Reconstruction

Objective We aimed to evaluate both the long-term surgical outcomes and patient-reported outcomes of free scapular flap (FSF) phalloplasty. MethodThe same surgical team performed phalloplasty in 66 patients using a FSF between March 2000 and September 2018. All patients had at least 24 months of follow-up. The surgical techniques used, complications observed, and surgical and patient-reported outcomes were retrospectively described. ResultA total of 66 patients with indications of penile trauma (n = 19), micropenis (n = 42), and self-amputation (n = 5) underwent FSF phalloplasty. Two patients (3%) had total flap necrosis and 1 (1.5%) had partial flap necrosis. The urethral complication rate was 18.2% (12/66 patients). All patients were able to void while standing after revision procedures or urethroplasty. We found that an FSF is a reliable donor site for penile reconstruction.ConclusionThe FSF phalloplasty creates an esthetically pleasing penis and allows voiding while standing. Most patients can engage in sexual activity. The main drawbacks of using this method are that patients experience different degrees of sensory recovery, and patients undergoing surgery with the “tube-in-tube” technique may find they are be limited by the thickness of the flap. However, by making full use of residual tissue, such as the micropenis glans or scrotal skin, patients can obtain good tactile and erogenous sensation. We believe that using an FSF complements the existing phalloplasty techniques.

Application of Hip Amputation Under Non-Ischemic Condition in the Treatment of Sarcomar

Background: Amputation is an effective treatment for sarcoma of the hip. Traditional amputation is performed by separating the major arteries and veins of the limb and blocking the blood supply to the limb, which may have adverse effects on the patient.Methods: Ten patients with pathologically clearly diagnosed bone and soft tissue sarcoma undergoing hip amputation in a non-ischemic state between April 2019 and April 2021 at the Affiliated Cancer Hospital of Harbin Medical University were selected. Factors related to operative time, intraoperative bleeding, phantom limb pain, incisional infection, and flap necrosis were statistically evaluated at 7 days postoperatively and 3 months postoperatively.Results: Ten patients were followed up for 3-24 months with a mean of 13 months. No bleeding secondary surgical complications occurred in all patients, and none had postoperative infections. Postoperative flap necrosis occurred in one case in the modified hemipelvic amputation patients, and no flap necrosis occurred in the hip disarticulation patients. In the non-ischemic hemipelvic amputation group, the operation time was 4.5-5.5h, with a mean of 5h, and the operation bleeding volume was 300-1000ml, with a mean of 700ml; in the hip disarticulation group, the operation time was 2.5-3.5h, with a mean of 2.9h, and the operation bleeding volume was 300-450ml, with a mean of 357ml; phantom limb pain in the non-ischemic amputation group 7 days after operation, the VAS pain score was 4 -6 points, mean 4.5 points; VAS pain score 3-4 points, mean 3.4 points at 3 months postoperatively.Conclusions: In hip amputation for bone and soft tissue sarcoma, the main arterial and venous approaches to the limb are ligated near the end of surgery, leaving the amputated limb in a non-ischemic state at the distal end of the amputation, without pathological reactions due to limb ischemia. Non-ischemic hip amputation is more suitable for the surgical treatment of locally advanced lesions of sarcoma.Trial registration: retrospectively registered

TP7.2.1 Outcomes of Modified Karydakis flap in the surgical management of sacrococcygeal pilonidal disease: A single surgeon’s experience

Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 month follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol. Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they had excision without closure. Pre, per and post-operative management for the remaining 87 patients was according to a standardised protocol. Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: • Seroma: 8/87 (9.2%) • Haematoma: 1/87 (1.2%) • SSI: 10/87 (11.5%) • Deep SSI: 4/87 (4.6%) • Superficial dehiscence: 7/87 (8.0%) • Re-admission: 4/87 (4.6%) • Return to theatre: 0 (0%) • Flap necrosis: 0 (0%) Secondary outcome: • Recurrence at 6 months: 2/87 (2.3%) Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

A PROSPECTIVE COMPARATIVE STUDY BETWEEN MODIFIEDRADICAL MASTECTOMY AND BREAST CONSERVATION SURGERY IN EARLY BREAST CANCER

Background: The improvement in the treatment of breast cancer is due to early diagnosis, better understanding of the natural history of this disease and therapeutic improvements over the years. There is a gradual shift away from radical surgery advocated by Halsted to the breast conservative surgery during the last few decades all over the world mainly influenced by the results of several large trials of lesser surgical procedures. Methods: Hospital based descriptive study was conducted on patients with Early Breast Cancer presenting to the Department of General Surgery in Guru Gobind Singh Medical College & Hospital, Faridkot. Results: Mean blood loss of the subjects of the BCS group was observed to be 44.07±15.76 ml as compared to 94.36 ± 31.50 ml in the subjects of the MRM. Mean operative time of the subjects of the BCS group was observed to be 46.03±8.68 minutes as compared to the mean operative time of 64.03±16.56 minutes in the subjects of the MRM group. Mean VAS score on day-1 in BCS group and in MRM group was 5.3±1.98 and 6.73±1.70 respecively. Mean VAS score on day-3 in BCS group and in MRM group was 4.46±1.50 and 5.1±1.56 respectively. Mean VAS score on day-5 in BCS group and in MRM group was 2.96±0.76 and 2.96±1.06 respectively. Seroma Formation was observed in 3.33 % cases in BCS group and 16.67 % in MRM group. Flap necrosis was observed in 0 % in BCS group whereas 10.00 % of the patients had flap necrosis in MRM group. Positive margins were absent in both BCS group and MRM group. Wound infection was observed in 6.67% of the patients in the BCS group and 20.00% in the MRM group. Quality of life score for BCS and MRM was 108.53±14.62 and 95.26±14.70 respectively. Conclusion: Breast conservation surgery should be the preferred treatment for Stage-I and Stage-II Breast cancer disease due to its lesser post-operative pain, shorter duration of surgery, lesser blood loss and short hospital stay thus helping in early returning to normal activity. Breast conservation surgery has better outcomes compared with Modified radical mastectomy. Keywords: BCS, MRM, Breast surgery

A Comparative Study on flap necrosis following Karydakis Flap Reconstruction and Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease – Our experience

Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease(SPSD) who underwent the Karydakis procedure and Z plasty at our centre concerning theperioperative findings, late postoperative results and recurrence. Patients and Methods: A total of30 patients presenting with SPSD at our centre underwent Karydakis flap repair and Z plasty fromMay 2019 to June 2021. These patients were then followed up and evaluated concerning operativetime, drain use, hospital stay, suture removal, complications, and recurrence. The adipocutaneousflap of Karydakis was devised to shift the natal cleft, while Z-plasty involves a fasciocutaneous flap.Results: The mean operative time was 60 min with a median hospital stay of 4 days. Drains wereremoved at a median of 5 days and sutures at a median of 15 days. The duration of hospitalisationfor the Karydakis procedure was found significantly lesser than that for Z-plasty Patients who werefollowed up for a median of 12 months. The overall complications were more in Z-plasty. Flapnecrosis developed in 30 % of the cases in the Z-plasty group, comparable to no recurrence seen inthe Karydakis procedure. Conclusion: Karydakis flap was found superior to Z-plasty, having lessseroma formation, no flap necrosis and no local hematoma Karydakis flap procedure is a relativelysimple procedure for SPSD and has advantages over Z-plasty technique like keeping scar away fromthe midline and flattening of the natal cleft, thus reducing local recurrence rates.