Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.
Drug Therapy ; Free Tissue Flaps* ; Hematoma ; Heparin* ; Humans ; Incidence ; Replantation ; Thrombocytopenia ; Thrombosis

Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion IBR rate in patients undergoing TM increased after NHI reimbursement.

Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion IBR rate in patients undergoing TM increased after NHI reimbursement.

PURPOSE: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. METHODS: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. RESULTS: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5+/-2.9 mm) and SLN (-) group (4.5+/-5.0 mm) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. CONCLUSION: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.
Biopsy ; Extremities ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphedema ; Lymphoscintigraphy ; Melanoma ; Methylene Blue ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin