Autologous Can Be Ambulatory: The Outpatient Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction

Ayyala, Haripriya S.; Atamian, Elisa K.; Le, Thuy-My T; Cohen, Stephanie

doi:10.1097/prs.0000000000007567

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…Although there was no direct evidence that the per patient cost at day center was lower than inpatients, according to other results [14,15,[35][36][37] , we speculated that day surgery for breast reconstruction can reduce medical expenses, decrease the economic burden of patients, maximize the use of hospital bed resources, speed up the turnover and utilization rate of hospital beds, and improve the efficiency of medical services.…”

Section: Discussionmentioning

confidence: 89%

“…Previous studies have suggested that modified radical surgery, BCS, and SLNB performed as a day case are feasible, safe, and beneficial for patients [25,27] . Recently, more centres are trying to develop same-day surgery of open N/SSM with breast reconstruction, including delayed latissimus dorsi flap breast reconstruction, and prove it is a safe and economic method [4][5][6]14] . However, this protocol has yet not to be widely implemented.…”

Section: Discussionmentioning

confidence: 99%

“…With enhanced recovery after surgery protocols showing significant benefit in major abdominal surgery, there has been a progressive trend to reduce inpatient stays for the majority of surgeries in recent history [5] . Therefore, under the pressure of COVID-19 global pandemic, in order to improve the resource utilization rate, some hospitals begin day surgery of breast reconstruction and believe it can safely be performed as same-day operations with no increased rates of postoperative morbidity [6,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

Feng

Xie

Zhou

et al. 2022

Preprint

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Background and Aims The aim of this study is to present a day surgery protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity and maximize treatment efficiency for breast cancer patients undergoing endoscopic nipple/skin-sparing mastectomy(E-N/SSM) with breast reconstruction through a single invisible axillary incision. Methods We retrospectively reviewed 60 consecutive patients(68 breasts) who underwent day surgery of E-N/SSM with implant-based reconstruction from July 2020 to November 2021 in West China Hospital. Postoperative complications, cost-effectiveness, and oncological safety were retrospectively analysed in patients. The SCAR-Q, BREAST-Q reconstruction module and photography were used to evaluate the breast satisfaction and quality of life(QoL). Results Sixty patients(68 breasts)with a mean age of 41.8±9.7 years were examined, with a median follow-up time of 6.5 months. Overall, the major complication rate and minor complication rate was 0% and 10.29%(7/68), respectively. Mean operation time was 123.94±24.26min(Surgeon A) and 180.64±16.68min (Surgeon B and C). The mean score of appearance scale of SCAR-Q was 60.9±12.7 at 3 months after operation. Breast satisfaction scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation (P<0.05); QoL scores (except for Physical Well-being: chest) at 6 months after operation were significantly better than those before operation(P<0.05). No local recurrence or distant metastasis developed. Conclusions Day surgery of E-N/SSM with immediate endoscopic breast reconstruction is safe and feasible in practice.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

Feng

Xie

Zhou

et al. 2022

Preprint

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“…Autologous reconstruction was not common in the ambulatory setting, which is expected given the need for close postoperative graft monitoring. Some institutions are actively evaluating the safety of ambulatory autologous reconstruction using modified operative techniques, postoperative anticoagulation, and multimodal pain control, but more comprehensive data are needed 15,16 . These protocols may still require observation overnight after surgery but no formal inpatient admission.…”

Section: Discussionmentioning

confidence: 99%

Delayed Versus Immediate Breast Reconstruction in the Ambulatory Surgery Setting

Das,

Mioton,

Thayer

et al. 2023

Ann Plast Surg

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Background Breast reconstruction remains an important part of a patient's journey after the diagnosis of breast carcinoma and treatment with mastectomy. Although inpatient immediate breast reconstruction has been described, there is a paucity information about whether similar procedures are performed in the ambulatory setting. Objective The authors sought to investigate rates and patterns for delayed and immediate breast reconstruction in the ambulatory surgery setting using nationally representative data from 2016 to 2019. Methods Using the Nationwide Ambulatory Surgery Sample database, we identified patients with an International Statistical Classification of Disease and Related Health Problems, Tenth Revision, procedure code for breast reconstruction. Demographic and clinical characteristics were recorded for each encounter of breast reconstruction, and linear regression and logistic regression were used to assess for trends and disparities. Results National weighted estimates for ambulatory breast reconstruction increased by 15.6% from 89 237 in 2016 to 103 134 in 2019, resulting in 377 109 procedures during the study period. Inflation-adjusted total charges for ambulatory breast reconstruction were $14 billion between 2016 and 2019, or 1.7% of overall charges for ambulatory surgery. Immediate reconstruction was performed in 34.7% (95% CI, 33.4%–36.1%) of cases and increased by 46.9% from 26 930 in 2016 to 39 559 in 2019. Racial disparities were observed in access, comorbidities, and spending. Conclusions Our findings indicate a moderate increase in ambulatory breast reconstruction with a substantial growth in the performance of immediate breast reconstruction in the ambulatory setting.

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“…To regain elbow function, bone or joint stabilization should be combined with adequate and functional soft tissue coverage (1-3). Many methods have been described for covering elbow defects such as axial fasciocutaneous flaps, distal musculocutaneous flaps, free tissue transfer, and local random musculocutaneous flaps (1,(4)(5)(6). Covering large and complex defects is much more difficult and laborious.…”

Section: Introductionmentioning

confidence: 99%

Key to the Success of a Pedicled Latissimus Dorsi Musculocutaneous Flap in Patients with Soft Tissue Defects Around the Elbow Complicated by Trauma

Gürbüz¹

2022

Erciyes Med J

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Background:The aim of this study was to examine the effectiveness of a pedicled latissimus dorsi musculocutaneous flap (PLDMF) applied to trauma-complicated large soft tissue defects in the upper extremity up to the elbow area. Methods:In this prospective follow-up, retrospective cohort-type study, six patients in whom a PLDMF was applied in our clinic for traumatic soft tissue defect around the elbow between 2014 and 2019 were included. The demographic data of the patients were recorded along with the size of the soft tissue defect, postoperative hospitalization time, follow-up, complications, and time to return to work. Nine months postoperatively, elbow and shoulder joint ROM was evaluated and the Q-DASH questionnaire was used. Results:The mean size of the defect in the 6 male patients of average age 39.8 ± 13.07 years was 272 cm 2 . In a patient who underwent amputation at the elbow level a flap was applied for an antecubital defect after replantation in the same session. One patient developed hematoma in the donor area, 1 patient had superficial necrosis distal to the flap, and 1 patient had superficial infection. They were discharged in 14-29 days. In all patients, the flaps survived and satisfactory results were obtained in terms of both the Q-DASH questionnaire and shoulder and elbow joint ROM. Conclusions:A PLDMF can be used safely in complicated soft tissue defects around the elbow joint that may require long treatment and would probably result in disability. The most common complication, distal necrosis, can be prevented by using intraoperative Doppler ultrasonography.

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Autologous Can Be Ambulatory: The Outpatient Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction

Cited by 5 publications

References 3 publications

Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

Delayed Versus Immediate Breast Reconstruction in the Ambulatory Surgery Setting

Key to the Success of a Pedicled Latissimus Dorsi Musculocutaneous Flap in Patients with Soft Tissue Defects Around the Elbow Complicated by Trauma

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