Breast reconstruction with deep inferior epigastric perforator flap (DIEP flap) is an optimal technique for massive tissue defect after breast cancer surgeries. Venous congestion is one of the main complications and the probable reasons include thrombus, lack of ramus communicans across the midline or between deep and superficial system, improper choice of anastomotic vein, et al. Clinical examination is the main method, and other auxiliary tests can also be used. Preoperative vascular evaluation is of great importance. The venous superdrainage is current preventive measure for congestion.

Objective To present the clinical effect of the delayed tissue expanding breast reconstruction with implants.Methods For those who received breast tumor surgeries,round-shaped expander was implanted for increasing skin coverage and silicone implant was used for breast reconstruction after several months' expanding.Results 15 relevant cases were included in this study with an average of 5.1 months expanding period.Only one patient received reoperation for capsular contracture and there was no complication in the other cases.Conclusions Delayed tissue expanding breast reconstruction with implants,with a wide indication,is an ideal reconstructive method which can reduce the interference of tumor recurrence and radiotherapy and avoid the trauma of donor site and the patch-like appearance of breast.

Objective:To introduce the efficacy and surgical experience of barbed sutures in wound closure of abdominoplasty.Methods:A prospective study of patients who underwent abdominoplasty in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from August to December 2021 was carried out. Barbed sutures and corresponding techniques were used for wound closure. These patients were included in the study group. Also, patients who underwent abdominoplasty from January to Jule 2021 and did not use barbed sutures were retrospectively included in the control group. Baseline data, surgical details, and follow-up records were reviewed and collected for statistical analysis. Normal distribution measurement data were expressed as Mean±SD, and independent sample t-test was used for comparison between the two groups. Count data were expressed as cases (%) and analyzed by Chi-square test or Fisher exact test. Results:Twenty female patients aged 31-51 years old with body mass index (BMI) of (23.2±2.5) kg/m 2 were included in the study group, followed up for 6-8 months. The control group included 18 female patients, aged 32-55 years old, with BMI of (23.9±3.7) kg/m 2, and were followed up for 6-12 months. The abdominoplasty incision length of the study group was (36.5±4.5) cm and that of the control group was (35.0±3.4) cm, and there was no statistical significance between the two groups ( P>0.05). The closure time of the study group was (51±7) min, significantly shorter than that of the control group [(98±15) min]( P<0.01). In the study group, 2 patients [10.0%(2/20)] had delayed wound healing caused by incision fat liquefaction. In the control group, delayed wound healing occurred in three patients (3/18), which was caused by incision fat liquefaction (1 case) and suture extrusion (2 cases). There was no significant difference in postoperative wound complication rates between the two groups ( P>0.05). The Vancouver scar scale at three-month follow-up was scored (5.9±1.3) in the study group, (5.6±1.2) in the control group, with no significant difference ( P>0.05). The follow-up visits observed no abdominal wall bulge, hernia, or hypertrophic scar. All patients reported satisfying aesthetic outcomes. Conclusion:Barbed sutures significantly shorten the wound closure time in abdominoplasty. The described closure technique is safe and beneficial for efficiency.

Objective:To analyze the reported cases of breast implant-associated squamous cell carcinoma (BIA-SCC) and to explore the diagnosis and treatment of BIA-SCC.Methods:BIA-SCC related literature published in PubMed database and Wanfang Medical database until March 2023 were searched. The country and year of publication, gender and age of patients, duration from initial implant placement to presentation, implant type, clinical manifestations, whether the tumor invaded extracapsular tissue, treatment, histopathological findings and follow-up result were analyzed.Results:Twelve BIA-SCC articles (15 cases in total) were included, including 11 cases from the United States, 2 cases from China, 1 case from Australia and 1 case from Japan. One case was published in 1992 and 14 cases from 2015 to 2023. There were 1 male and 14 female patients. Patient age of onset was (55.3±9.6) years. The time from implant insertion to onset of BIA-SCC was (24.5±9.4) years. Implant types include smooth implants, textured implants, silicone gel implants, saline implants, and liquid silicone gel. All 15 patients had breast pain and swelling. Four cases presented erythema, thin or broken skin; and capsular contracture was found in 7 cases. Three tumors were confined to the capsule, 10 invaded the outer capsule (most of them had distant metastases), and 2 were unspecified. During the treatment, breast implants were removed and capsulectomy was performed, followed by radiotherapy (7 cases) or chemotherapy (8 cases). Post-operative histopathologic findings suggested squamous cell carcinoma, or a transition from atypical squamous metaplasia to increased cell atypia and abnormal immature keratinization. After the operation, 9 cases were followed up for 3 months to more than 8 years, of which 5 cases did not have obvious recurrence, and 4 cases had multiple metastasis, died or received palliative end-of-life treatment.Conclusion:BIA-SCC should be excluded if breast swelling and pain occur many years after breast prosthesis implantation, and adequate systemic evaluation should be conducted to check whether there is distant metastasis. The diagnosis was confirmed by histopathological examination of the tumor, timely removal of implants, extensive resection of the tumor, and systematic treatment combined with other auxiliary methods.

Objective:To introduce the efficacy and surgical experience of barbed sutures in wound closure of abdominoplasty.Methods:A prospective study of patients who underwent abdominoplasty in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from August to December 2021 was carried out. Barbed sutures and corresponding techniques were used for wound closure. These patients were included in the study group. Also, patients who underwent abdominoplasty from January to Jule 2021 and did not use barbed sutures were retrospectively included in the control group. Baseline data, surgical details, and follow-up records were reviewed and collected for statistical analysis. Normal distribution measurement data were expressed as Mean±SD, and independent sample t-test was used for comparison between the two groups. Count data were expressed as cases (%) and analyzed by Chi-square test or Fisher exact test. Results:Twenty female patients aged 31-51 years old with body mass index (BMI) of (23.2±2.5) kg/m 2 were included in the study group, followed up for 6-8 months. The control group included 18 female patients, aged 32-55 years old, with BMI of (23.9±3.7) kg/m 2, and were followed up for 6-12 months. The abdominoplasty incision length of the study group was (36.5±4.5) cm and that of the control group was (35.0±3.4) cm, and there was no statistical significance between the two groups ( P>0.05). The closure time of the study group was (51±7) min, significantly shorter than that of the control group [(98±15) min]( P<0.01). In the study group, 2 patients [10.0%(2/20)] had delayed wound healing caused by incision fat liquefaction. In the control group, delayed wound healing occurred in three patients (3/18), which was caused by incision fat liquefaction (1 case) and suture extrusion (2 cases). There was no significant difference in postoperative wound complication rates between the two groups ( P>0.05). The Vancouver scar scale at three-month follow-up was scored (5.9±1.3) in the study group, (5.6±1.2) in the control group, with no significant difference ( P>0.05). The follow-up visits observed no abdominal wall bulge, hernia, or hypertrophic scar. All patients reported satisfying aesthetic outcomes. Conclusion:Barbed sutures significantly shorten the wound closure time in abdominoplasty. The described closure technique is safe and beneficial for efficiency.

Objective:To analyze the reported cases of breast implant-associated squamous cell carcinoma (BIA-SCC) and to explore the diagnosis and treatment of BIA-SCC.Methods:BIA-SCC related literature published in PubMed database and Wanfang Medical database until March 2023 were searched. The country and year of publication, gender and age of patients, duration from initial implant placement to presentation, implant type, clinical manifestations, whether the tumor invaded extracapsular tissue, treatment, histopathological findings and follow-up result were analyzed.Results:Twelve BIA-SCC articles (15 cases in total) were included, including 11 cases from the United States, 2 cases from China, 1 case from Australia and 1 case from Japan. One case was published in 1992 and 14 cases from 2015 to 2023. There were 1 male and 14 female patients. Patient age of onset was (55.3±9.6) years. The time from implant insertion to onset of BIA-SCC was (24.5±9.4) years. Implant types include smooth implants, textured implants, silicone gel implants, saline implants, and liquid silicone gel. All 15 patients had breast pain and swelling. Four cases presented erythema, thin or broken skin; and capsular contracture was found in 7 cases. Three tumors were confined to the capsule, 10 invaded the outer capsule (most of them had distant metastases), and 2 were unspecified. During the treatment, breast implants were removed and capsulectomy was performed, followed by radiotherapy (7 cases) or chemotherapy (8 cases). Post-operative histopathologic findings suggested squamous cell carcinoma, or a transition from atypical squamous metaplasia to increased cell atypia and abnormal immature keratinization. After the operation, 9 cases were followed up for 3 months to more than 8 years, of which 5 cases did not have obvious recurrence, and 4 cases had multiple metastasis, died or received palliative end-of-life treatment.Conclusion:BIA-SCC should be excluded if breast swelling and pain occur many years after breast prosthesis implantation, and adequate systemic evaluation should be conducted to check whether there is distant metastasis. The diagnosis was confirmed by histopathological examination of the tumor, timely removal of implants, extensive resection of the tumor, and systematic treatment combined with other auxiliary methods.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.

Objective:To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein (SIEV) in delayed single-pedicled deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed. According to whether SIEV-internal thoracic vein anastomosis was performed, they were divided into superdrainaged group and non-superdrainaged group. The diameter of SIEV and the time required for anastomosis were recorded. The total operation time, flap ischemia time, hospital stay, the rates of flap diffuse congestion, overall complications and second operation were compared between the two groups. The relative risks of flap diffuse congestion, complications and second operation were calculated. SPSS 24.0 software was used for data analysis. Measurement data was expressed as Mean±SD, independent sample t test was used for analysis. Counting data was expressed as %, and χ2 test was used for analysis. P<0.05 was considered statistically significant. Results:A total of 45 patients were included, including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group. The total operation time was (7.7±1.9) h and (8.4±1.5) h, the flap ischemia time was (89.5±10.4) min and (92.6±12.3) min, and the hospital stay was (6.6±1.8) d and (6.6±2.0) d, respectively. There were no significant differences ( P>0.05). In the superdrainaged group, the diameter of SIEV was (2.5±0.3) mm, and manual suture was used. The time required for anastomosis of one SIEV was (12.2±2.3) min. The rates of diffuse congestion, recipient site complications, donor site complications and second operation were 7.7%(2/26), 15.4%(4/26), 7.7%(2/26) and 15.4%(4/26) in the non-superdrainaged group, and 0(0/19), 5.3%(1/19), 10.5%(2/19) and 5.3%(1/19) in the superdrainaged group, respectively. There were no significant differences between the two groups ( P>0.05). The relative risks were 3.7, 2.9, 0.7 and 2.9, respectively. Conclusion:Prophylactic superdrainage using SIEV is safe and effective. It can minimize the potential rate of diffuse venous congestion and secondary surgery, and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.

In deep inferior epigastric perforator (DIEP) flap breast reconstruction, diffuse venous congestion caused by non-pedicle causes, such as lack of effective communication between deep and superficial venous systems, is very rare. In this paper, a case of young woman who underwent DIEP breast reconstruction after breast cancer mastectomy was reported. Imaging findings showed the absence of bilateral dominant perforators and the lack of communication between the deep and superficial venous system. During operation, the superficial inferior epigastric vessels were dissected in advance. Indocyanine green angiography showed arterial perfusion insufficiency and venous congestion.The flap was successfully salvaged by supercharging/draining with superficial inferior epigastric vessels, preserving the abdominal function of the young patient to the greatest extent.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.