Simultaneous Lymphatic Superficial Circumflex Iliac Artery Perforator Flap Transfer from the Zone 4 Region in Autologous Breast Reconstruction Using the Deep Inferior Epigastric Artery Perforator Flap: A Proof-of-Concept Study
The incidence of upper extremity lymphedema after breast cancer treatment is reported to be 14% after axillary lymph node dissection (ALND) and 33% after ALND and regional lymph node dissection. The present report describes a novel method in which the afferent lymphatic vessels are harvested with th...
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Published in | Journal of clinical medicine Vol. 11; no. 3; p. 534 |
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Language | English |
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Abstract | The incidence of upper extremity lymphedema after breast cancer treatment is reported to be 14% after axillary lymph node dissection (ALND) and 33% after ALND and regional lymph node dissection. The present report describes a novel method in which the afferent lymphatic vessels are harvested with their lymph nodes from the Zone 4 region as a separate flap, the superficial circumflex iliac artery perforator (SCIP) flap, in the setting of autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap. From September 2017 to September 2020, seven female patients with an average age of 46.9 years (range: 39 to 54 years) underwent autologous breast reconstruction using the DIEP flap and the lymphatic SCIP flap procured separately from the Zone 4 region. All patients had undergone ALND, four patients had undergone radiation therapy, and three patients had established lymphedema at the time of reconstruction. All lymphatic SCIP flaps survived completely. Lymphedema did not occur in any of the four patients to whom the lymphatic flap was transferred for a preventive purpose (average follow-up: 37.5 months). In three patients with established lymphedema at the time of reconstruction, the average rate of estimated volume decrease at the last follow-up (average: 29.0 months) was 12.6%. A lymphatic SCIP flap procured from the Zone 4 region in DIEP flap breast reconstruction can contribute to improvement or prevention of lymphedema with no additional donor site. |
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AbstractList | The incidence of upper extremity lymphedema after breast cancer treatment is reported to be 14% after axillary lymph node dissection (ALND) and 33% after ALND and regional lymph node dissection. The present report describes a novel method in which the afferent lymphatic vessels are harvested with their lymph nodes from the Zone 4 region as a separate flap, the superficial circumflex iliac artery perforator (SCIP) flap, in the setting of autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap. From September 2017 to September 2020, seven female patients with an average age of 46.9 years (range: 39 to 54 years) underwent autologous breast reconstruction using the DIEP flap and the lymphatic SCIP flap procured separately from the Zone 4 region. All patients had undergone ALND, four patients had undergone radiation therapy, and three patients had established lymphedema at the time of reconstruction. All lymphatic SCIP flaps survived completely. Lymphedema did not occur in any of the four patients to whom the lymphatic flap was transferred for a preventive purpose (average follow-up: 37.5 months). In three patients with established lymphedema at the time of reconstruction, the average rate of estimated volume decrease at the last follow-up (average: 29.0 months) was 12.6%. A lymphatic SCIP flap procured from the Zone 4 region in DIEP flap breast reconstruction can contribute to improvement or prevention of lymphedema with no additional donor site. |
Author | Yoshimatsu, Hidehiko Yano, Tomoyuki Karakawa, Ryo Fuse, Yuma |
AuthorAffiliation | Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan; ryo.kyara@gmail.com (R.K.); yuyuma.fuse@gmail.com (Y.F.); yanoaprs@icloud.com (T.Y.) |
AuthorAffiliation_xml | – name: Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan; ryo.kyara@gmail.com (R.K.); yuyuma.fuse@gmail.com (Y.F.); yanoaprs@icloud.com (T.Y.) |
Author_xml | – sequence: 1 givenname: Hidehiko surname: Yoshimatsu fullname: Yoshimatsu, Hidehiko organization: Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan – sequence: 2 givenname: Ryo orcidid: 0000-0002-6096-8094 surname: Karakawa fullname: Karakawa, Ryo organization: Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan – sequence: 3 givenname: Yuma orcidid: 0000-0002-1045-3068 surname: Fuse fullname: Fuse, Yuma organization: Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan – sequence: 4 givenname: Tomoyuki orcidid: 0000-0001-6319-9019 surname: Yano fullname: Yano, Tomoyuki organization: Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan |
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Keywords | superficial circumflex iliac artery perforator flap lymphedema breast reconstruction deep inferior epigastric artery perforator flap |
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SubjectTerms | Breast cancer breast reconstruction Clinical medicine deep inferior epigastric artery perforator flap Lymphatic system Lymphedema Radiation therapy superficial circumflex iliac artery perforator flap Veins & arteries |
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Title | Simultaneous Lymphatic Superficial Circumflex Iliac Artery Perforator Flap Transfer from the Zone 4 Region in Autologous Breast Reconstruction Using the Deep Inferior Epigastric Artery Perforator Flap: A Proof-of-Concept Study |
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