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The purpose of the study was to assess the feasibility of using the propeller flap to cover a large axillary fossa defect following lymph node dissection in breast cancer patients.Material and Methods. One hundred breast cancer patients underwent surgery. Out of them, 64 underwent Madden modified radical mastectomy and 36 radical breast resection using a propeller muscle flap. Out of 100 patients, 61 were followed up (50 after mastectomy and 11 after radical resection using a propeller flap). Fifteen patients were randomly selected for examination of the flap using ultrasound (2 patients after radical resection, 13patients after radical mastectomy). The follow-up time was from 3 to 6 months. We studied the following: bleeding in the postoperative period, hematoma, duration of lymphorrhea, duration of hospitalization, ultrasound findings, hand function, size of the upper limb, and physical activity.Results. No statistically significant differences in the number of complications related to the surgery extent were found. Here was no bleeding. Small hematoma was observed in one patient who underwent breast resection. Forty-three (70.49 %) patients did not have lymphorrhea after drainage removal. Lymphorrhea was observed for a month in 9 (14.75 %) patients, for 1–2 months in 4 (6.56 %) patients, and for 3 months or more in 5 (8.2 %) patients – 3 months or more. Twelve (19.67 %) patients developed lymphoedema of the arm. Hospitalization period was 7 bed-days in 90.0 % of cases. The flap viability reached 100.0 %. In 54 (88.53 %) of 61 patients, the active function of the arm recovered. Thirty-eight (62 %) patients had ECOG 1 status 3 years after surgery.Conclusion. The flap made it possible to solve the local problems of covering the axillary neurovascular bundle during lymphadenectomy for breast cancer and eliminating a large axillary fossa defect. The results obtained demonstrated high engraftment rates with a small number of complications, regardless of the surgery extent.
The purpose of the study was to assess the feasibility of using the propeller flap to cover a large axillary fossa defect following lymph node dissection in breast cancer patients.Material and Methods. One hundred breast cancer patients underwent surgery. Out of them, 64 underwent Madden modified radical mastectomy and 36 radical breast resection using a propeller muscle flap. Out of 100 patients, 61 were followed up (50 after mastectomy and 11 after radical resection using a propeller flap). Fifteen patients were randomly selected for examination of the flap using ultrasound (2 patients after radical resection, 13patients after radical mastectomy). The follow-up time was from 3 to 6 months. We studied the following: bleeding in the postoperative period, hematoma, duration of lymphorrhea, duration of hospitalization, ultrasound findings, hand function, size of the upper limb, and physical activity.Results. No statistically significant differences in the number of complications related to the surgery extent were found. Here was no bleeding. Small hematoma was observed in one patient who underwent breast resection. Forty-three (70.49 %) patients did not have lymphorrhea after drainage removal. Lymphorrhea was observed for a month in 9 (14.75 %) patients, for 1–2 months in 4 (6.56 %) patients, and for 3 months or more in 5 (8.2 %) patients – 3 months or more. Twelve (19.67 %) patients developed lymphoedema of the arm. Hospitalization period was 7 bed-days in 90.0 % of cases. The flap viability reached 100.0 %. In 54 (88.53 %) of 61 patients, the active function of the arm recovered. Thirty-eight (62 %) patients had ECOG 1 status 3 years after surgery.Conclusion. The flap made it possible to solve the local problems of covering the axillary neurovascular bundle during lymphadenectomy for breast cancer and eliminating a large axillary fossa defect. The results obtained demonstrated high engraftment rates with a small number of complications, regardless of the surgery extent.
Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.
Oncological morbidity remains one of the first places in the structure of all human diseases. In this regard, the number of radical surgeries performed with regional lymphodissection is also increasing, which is the main cause of postoperative lymphorrhoea and lymphostasis. Unfortunately, not everyone considers lymphorrhea a dangerous consequence of lymphadenectomy, so there is little information in the literature. This article presents data on the incidence of lymphorrhea and other lymphatic complications in the postoperative period in oncosurgical patients.
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