Treatment of chest wall osteoradionecrosis with contralateral breast Y-V flap: case report

Introduction:Chest wall osteoradionecrosis(ORN) in breast cancer is one of the most serious complications of radiation therapy. Treatment requires wide debridement and coverage with a well-vascularized flap. However, the extensive radiation-induced injury, and a limit to performing wide resection of the injured bones are challaged to treatment. Herein, we present our experience with chest wall ORN treated with contralateral breast Y-V flap.Case presentationAn 81-year-old woman diagnosed with ORN of the chest wall had a severe ptotic breast. Reconstruction was planned to cover the open wound of the chest wall using redundant contralateral breast tissue. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast while preserving the perforators of the left lateral thoracic artery. The flap was spread in a Y-V advancement fashion to cover the open wound. The patient was discharged 2 weeks after surgery following suture removal. At 19 months post-operation, there were no complications or recurrences of ulcers. The patient was satisfied with the short recovery time and the surgical results.ConclusionThe contralateral breast Y-V flap allows simple and quick reconstruction, and having more options for chest wall reconstruction will allow for a more flexible treatment plan for each patient.

Assessment of breast arteries and lymph nodes by 3D MR angiography enhancement imaging: feasibility and pilot clinical results

Background Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients’ (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.

BILATERAL VARIATION IN THE BRANCHING PATTERN OF THE AXILLARY ARTERY - A CASE REPORT

During routine dissection of a male cadaver for I year MBBS students in the department of Anatomy bilateral variations in the branching pattern of Axillary artery were observed. In the present study it was observed that, on the left side, the subscapular artery which usually arises from the third part of Axillary artery was found to be originating from the second part along with the lateral thoracic artery and thoraco-acromial artery whereas anterior circumflex humeral artery and posterior circumflex humeral artery originated from the third part as usual. On the right side, the circumflex scapular artery and the Thoracodorsal artery were arising as a common trunk from the third part which is not the usual pattern. Knowing such variations is of utmost significance in performing various clinical procedures by Vascular surgeons, Radiologists, Clinical anatomists and in interventional and diagnostic procedures in cardiovascular diseases.

Collateral Formation from Left Lateral Thoracic Artery to the Adamkiewicz Artery

A 68-year-old man who had undergone descending thoracic aortic replacement was referred to our hospital with a thoracoabdominal aortic aneurysm. During the original surgery, the Adamkiewicz artery was directly reconstructed. However, multidetector row computed tomography showed occlusion of the reconstructed artery at its orifice, with supply by a collateral vessel from the left lateral thoracic artery. With careful incision to avoid damage to the collateral vessel, no postoperative neurological deficit was observed.

An Anatomical Variation of Terminal Branches of the Thoracoacromial Artery – Case Report

Introduction: Mapping the branching patterns of the thoracoacromial artery has a particular practical importance. Familiarity with the different anatomical variations is essential for successful surgical procedures in the anterior shoulder region.Case presentation: We present an unusual anatomical variant observed during the dissection of a cadaver at the Department of Anatomy and Embryology of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania. According to the classical description, the thoracoacromial artery originates from the second part of the axillary artery, but we observed an unusual branching variation: the thoracoacromial artery provided a subscapular branch right after its origin, then it split into a pectoral branch, the lateral thoracic artery, and a common trunk that gave a second pectoral branch and a deltoid-acromial branch. The clavicular branch was missing.Conclusions: The case we presented demonstrates that there are anatomical variations of the axillary artery system that are partially or entirely different from the classical descriptions. Our study describes a variation of the thoracoacromial artery that has not been reported so far.

Die Verwendung lokaler Perforatorlappenplastiken der Arteria thoracica lateralis (LTAP) und Arteria thoracodorsalis (TDAP) zur axillären Rekonstruktion bei Hidradenitis suppurativa

ZusammenfassungDie Hidradenitis suppurativa ist eine chronisch entzündliche Erkrankung von Terminalfollikeln und apokrinen Drüsen der Axilla. Die sichere und kosmetisch ansprechende Rekonstruktion großer Defekte nach radikaler Exzision erkrankter Areale in der Axilla stellt eine operative Herausforderung an den Chirurgen dar. Die laterale Thoraxregion bietet – neben weiteren – die Möglichkeit zur lokalen Perforatorlappenplastik, basierend auf der Arteria thoracodorsalis und der Arteria thoracica lateralis. Diese Arbeit zeigt erstmals in großer Fallzahl die Rekonstruktion axillärer Defekte durch den lateral thoracic artery perforator-Lappen. Insgesamt 13 Lappenplastiken (10 lateral thoracic artery perforator-Lappen und 3 thoracodorsal artery perforator-Lappen) wurden eingeschlossen. Die Patienten wurden im Rahmen der Nachuntersuchung auf postoperative Komplikationen nach Clavien-Dindo, das subjektive kosmetische Ergebnis, die Abduktionsfähigkeit des Arms in Form der range of motion und auf die Rezidivrate hin untersucht. Hierbei kam es weder zu einem Lappenuntergang noch zu einer Lappenteilnekrose. Bis auf einen Fall bewerteten alle Patienten das kosmetische Ergebnis als sehr gut oder gut. Die postoperative Schulterbeweglichkeit war stets uneingeschränkt mit einer maximalen Abduktionsfähigkeit von 178,8 ± 4,2° und in der postoperativen Nachuntersuchung von durchschnittlich 27,2 ± 14,4 Monaten kam es in keinem Fall zu einem Rezidiv. Die Verwendung der lokalen fasziokutanen Perforatorlappen der Arteria thoracica lateralis und Arteria thoracodorsalis zur plastisch-chirurgischen Behandlung der axillären HS im Stadium II und III führt zu guten ästhetischen und funktionellen Ergebnissen.

Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study

Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit.Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates.Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers.Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.