Reconstruction of Lymphedema and Breast

• Main Author: Olivia Ho
• Other Authors: F. C. Wei
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/wqbtc9

碩士 === 長庚大學 === 顯微手術國際碩士學位學程 === 105 === (1) Critical Ischemia Time, Perfusion and Drainage Function of Vascularized Lymph Nodes Chin-Yu Yang1, § M.Sc., Olivia A. Ho,2,§ M.D., Ming-Huei Cheng,1,2 M.D., M.B.A., Hui-Yi Hsiao,1* Ph.D. 1Center for Tissue Engineering, Chang Gung Memorial Hospital, 2Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan §These authors contributed equally. Abstract BACKGROUND Vascularized lymph node transfer is a promising surgical treatment for lymphedema. This study investigates the effect of ischemia on the lymph drainage efficiency of vascularized lymph node flaps and the critical ischemia time of lymph nodes. METHODS Twenty-four lymph nodes containing groin flaps in 12 Sprague-Dawley rats were dissected. Clamping of the vascular pedicle was performed for 0, 1, 3, 5, 6, and 7 hours; then, reperfusion of the vascular pedicle was allowed for one hour. Perfusion and ischemic changes were assessed using indocyanine green (ICG) lymphography, laser Doppler flowmetry, and histological studies with associated LYVE-1, CD68, DAPI, TUNEL and GSH assay stains. RESULTS The mean latency period of the groin lymph node flaps was 247±67, 83±15, 72± 42, 30±18, and 245±85 seconds in the 0-, 1-, 3-, 5- and 6-hour groups, respectively. Perfusion detected by laser Doppler was 85.2±14.5, 87.2±36.7, 129.8±33.7, 140.4±148.5, 156.1±91.4 and 41.2±34.8 perfusion units at ischemia times of 0, 1, 3, 5, 6, and 7 hours, respectively. Cell damage measured by glutathione was 46.8±10.2, 67.7±14.2, 62.8±15.4, 126.6±5.9, 259.0±70.3, and 109.1±27.5 at ischemia times of 0, 1, 3, 5, 6, and 7 hours, respectively. Histologically, as ischemia time increased, hemorrhage and congestion became more severe. CONCLUSIONS The critical ischemia time of vascularized lymph nodes was 5 hours, as verified by the ICG lymphatic fluid uptake, laser Doppler perfusion, and histologic assessments. Lymphatic drainage and perfusion of vascularized lymph nodes improve with increased ischemia time up until 5 hours. (2) Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants Olivia A. Ho M.D., ^ Yi-Ling Lin M.Sc., ^ Jung-Ju Huang M.D., ^ Ming-Huei Cheng M.D. M.B.A. ^* ^Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan Abstract Background: Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants. Methods: Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed. Results: Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed). Conclusions: The CATS technique can be performed safely, with a desirable aesthetic outcome, and symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.