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Annals of Plastic Surgery:
doi: 10.1097/SAP.0000000000000322
Clinical Articles

Simultaneous Breast Reconstruction and Treatment of Breast Cancer–Related Upper Arm Lymphedema With Lymphatic Lower Abdominal Flap

Chen, Ru MD*; Mu, Lan MD, PhD*; Zhang, Han MD*; Xin, Minqiang MD, PhD*; Luan, Jie MD, PhD*; Mu, Dali MD, PhD*; Liu, Chunjun MD, PhD*; Ji, Kai MD*; Hu, Jiejie MD*; Sun, Jingjing MD*; Xuan, Lixue MD; Rong, Yongying MD; Zheng, Liping MD§; Tang, Peng MD; Zhong, Xiaojie MD; Wu, Huangfu MD; Zou, Tianning MD#; Yang, Zhuangqing MD#; Becker, Corrine MD, PhD**

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Abstract

Background

This study was designed to introduce the key points about the transplantation of lower abdominal flap with vascularized lymph node and to evaluate the effect of breast restoration, breast reconstruction, and lymphatic transplantation to treat upper limb lymphedema after breast cancer surgery.

Materials and Methods

The study was based on the retrospective study on 10 cases of postmastectomy lymphedema during January 2008 to March 2011. All patients, aged 36 to 50 years, have had one-side upper-limb lymphedema for 3 to 5 years. Six patients had accepted radiotherapy. Four patients had a diagnosis of severe lymphedema, and 2 patients had moderate lymphedema. The isotope radiography before the operation showed obstruction of lymphatic return, and the multidetector computed tomography that followed delivered a clear picture of the abdominal flap blood supply and the blood vessels in the breasts. During the operation, the scar contracture of the axilla was completely relaxed, and all patients accepted abdominal transplantation of lower abdominal flap with vascularized lymph node. After the operation, the elastic bandages were applied for one year as an adjuvant therapy. The follow-up visits were conducted 1, 3, 6, and 12 months after the surgery. The measurement indexes included mid-upper arm circumference, clinical symptoms, and lymphoscintigraphy.

Results

All flaps worked well. One patient was found to have delayed wound healing; one patient saw no obvious improvement in lymphedema; 7 patients with lymphedema were relieved with apparent improvement in the affected limbs’ mean perimeter and clinical symptoms; one patient recovered; and another patient was lost to follow-up. The mean reduction was 2.122 ± 2.331 cm, and the reduction of the lymphedematous limb was statistically significant between the preoperative and 12-month postoperative groups (P < 0.05). The results were good in 4 patients and excellent in one patient.

Conclusions

The transplantation of abdominal flap with vascularized lymph node and breast reconstruction, accompanied by the treatment to upper limb lymphedema and using elastic bandages as an adjuvant therapy, is considered to be an effective method to restore the configuration and function of breasts. Long-term follow-up visits are undergoing, especially the lymphoscintigraphy, 2 years after the operation.

Copyright © 2014 by Lippincott Williams & Wilkins

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