Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes

Pujji, Ojas; Blackhall, Vivienne; Romics, László; Vidya, Raghavan

doi:10.1016/j.ejso.2021.03.249

Cited by 15 publications

(8 citation statements)

References 31 publications

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“…These complications led to revision surgery in 3.6% of cases. When comparing the use of perforator flaps in HS to other indications, a recent literature review reported an overall complication rate of 12.3% for 432 thoracic pedicled perforator flaps used for reconstruction after breast cancer [ 77 ]. In the axillary region, Jiang et al [ 78 ] described a complication rate of 12.5% in a series of 32 TDAPs used to treat axillary scar contractures.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Vaillant

Berkane

Lupon

et al. 2022

JCM

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Introduction: Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. Patients and Methods: PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. Results: Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. Conclusions: Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Vaillant

Berkane

Lupon

et al. 2022

JCM

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“…The application of CWPFs to the above-mentioned scenarios is a novel application [ 14 ]. We have shown in our study that 81.81% of the patients underwent surgery without any complications, and all patients (100%) were either satisfied or very satisfied with the results of the surgery (as evaluated by the PROMs questionnaire).…”

Section: Discussionmentioning

confidence: 99%

Pushing the Boundaries of Pedicled Chest Wall Perforator Flaps in Oncoplastic Breast Surgery

Laroiya¹,

Tan²,

Zafar³

et al. 2023

Cureus

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Among 145 chest wall perforator flaps (CWPFs) performed at City Hospital, Birmingham (September 2017-February 2022), 11 were for novel indications, four were for whole breast reconstructions, two were for implant salvage procedures, three were CWPFs with skin paddle to replace excised skin/nipple-areola complex, and two were for upper inner quadrant tumours.Tumour characteristics and post-operative complications were noted. Patient-reported outcomes measures (PROMs) were measured using a questionnaire adapted from the National Mastectomy and Breast Reconstruction Audit (NMBRA) study.Among 11 patients, nine (81.81%) did not develop any complications. Ten patients responded to PROMs (median follow-up of eight months). The PROMs assessment showed that all patients (100%) were satisfied with the post-operative breast appearance. Of the patients, 90% (9/10) felt the results of their surgery to be good, very good, or excellent. Of the patients, 70% (7/10) said that they have no/little persistent pain. None of the patients had difficulty carrying out normal activities.Thus, the applications of CWPFs could be extended for whole breast reconstruction, implant salvage procedures, where skin paddle is needed, and for upper inner quadrant tumours.

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“…In the European Society of Breast Cancer Specialists (EUSOMA) criteria, it is mandatory that a breast surgeon should be able to perform level I and II oncoplastic techniques [ 41 ]. Even level III (e.g., chest wall perforator flaps) can be considered part of a dedicated breast surgeon's oncoplastic armamentarium [ 42 ]. Furthermore, the EUSOMA criteria emphasize the need to educate and train new breast surgeons in OPBCS by experienced oncoplastic breast surgeons.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Breast Conserving Surgery: Is There a Need for Standardization? Results of a Nationwide Survey

et al. 2022

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Introduction The NABON Breast Cancer Audit showed that more than 70% of the Dutch women undergoing surgery for breast cancer (BC) maintained their breast contour by breast conserving surgery (BCS) or by immediate reconstruction after ablative surgery. The proportion of oncoplastic surgery applied in patients undergoing breast conserving treatment (BCT) remains unknown. The aim of our study was to assess the need for standardization of oncoplastic breast conserving surgery (OPBCS) in an attempt to enable measurement of the quality of OPBCS. Methods To gain a better understanding of current practice in OPBCS we sent a questionnaire to all breast surgeons in the Netherlands who are member of the breast surgery working group (n=134). Results A total of 60 breast surgeons, representing different hospitals in the Netherlands, responded. 61.7% of the breast surgeons performed BCS in 60%-100% of their patients. 68.3% responded that BCS was performed using OPS techniques in up to 40% of their patients. OPBCS was defined as level I volume displacement by 45.2% of the breast surgeons and as BCS performed by a breast surgeon and plastic surgeon together by 32.3% of the breast surgeons. 94.5% indicated that there is a need for standardization of the definition of OPBCS in the Netherlands. Conclusion This study demonstrates that OPBCS is a major part of daily clinical practice of Dutch breast surgeons treating BC patients. Despite of this, there is no clear definition of OPS in BCT in the Netherlands. Only after standardization, a classification code and quality indicator can be initiated for OPBCS. Ultimately, this will facilitate improvement in quality of BC care.

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Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes

Cited by 15 publications

References 31 publications

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Pushing the Boundaries of Pedicled Chest Wall Perforator Flaps in Oncoplastic Breast Surgery

Oncoplastic Breast Conserving Surgery: Is There a Need for Standardization? Results of a Nationwide Survey

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