Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Recent advancement in natural language processing (NLP) and medical imaging empowers the wide applicability of deep learning models. These developments have increased not only data understanding, but also knowledge of state-of-the-art architectures and their real-world potentials. Medical imaging researchers have recognized the limitations of only targeting images, as well as the importance of integrating multimodal inputs into medical image analysis. The lack of comprehensive surveys of the current literature, however, impedes the progress of this domain. Existing research perspectives, as well as the architectures, tasks, datasets, and performance measures examined in the present literature, are reviewed in this work, and we also provide a brief description of possible future directions in the field, aiming to provide researchers and healthcare professionals with a detailed summary of existing academic research and to provide rational insights to facilitate future research.
Humans ; Natural Language Processing ; Surveys and Questionnaires

Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To explore the selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection.Methods:From January 2011 to February 2017, 31 patients with vulvar tumor who were admitted to Hunan Cancer Hospital underwent repair of wound after tumor resection with various flaps/myocutaneous flaps. The patients were composed of 5 males and 26 females, aged 39-76 years, with 27 vulvar cancer and 4 Paget′s disease in primary diseases. The size of defects after vulvar tumor radical resection ranged from 8.0 cm×4.5 cm to 27.5 cm×24.0 cm. According to the theory of perforasome, the defects were repaired by the external pudendal artery perforator flap, deep inferior epigastric artery perforator flap, rectus abdominis myocutaneous flap, anterolateral thigh flap, internal pudendal artery perforator flap, gracilis myocutaneous flap, and profunda artery perforator flap based on the specific size and location of perineum and groin where the defect was located. According to the blood supply zone of flap, totally 17 local translocation flaps, 18 axial flaps/myocutaneous flaps, and 7 V-Y advancement flaps were resected, with an area of 7.0 cm×4.0 cm to 21.0 cm×13.0 cm. All the flaps/myocutaneous flaps were transferred in pedicled fashion, and the donor sites were closed without tension. The number of flaps/myocutaneous flaps, wound closure, flaps/myocutaneous flaps survival, and follow-up were observed and recorded.Results:Altogether 42 flaps/myocutaneous flaps were harvested in 31 patients. Two flaps/myocutaneous flaps were used in 11 cases for large circular defect repair. All the defects achieved tension-free primary closure. The blood supply of 32 flaps/myocutaneous flaps was good, while insufficient blood supply was noted in the other 10 flaps/myocutaneous flaps. Seventeen flaps/myocutaneous flaps survived smoothly. Wound dehiscence occurred in 5 flaps/myocutaneous flaps 8 to 14 days postoperatively, which was healed with dressing change. Temporary congestion was noted in 7 flaps/myocutaneous flaps 2 to 5 days postoperatively, which recovered without special treatment. Three flaps/myocutaneous flaps had infection 7 to 15 days postoperatively, two of which recovered after dressing change, while the other one had partial necrosis and received debridement and direct closure. Two flaps/myocutaneous flaps were totally necrotic 8 to 15 days postoperatively, which were repaired with pedicled rectus abdominis myocutaneous flap after debridement. Seven flaps/myocutaneous flaps had partial necrosis 7 to 20 days postoperatively and were healed after dressing change. Twenty-four patients were followed up for 9-38 months. The color of flaps/myocutaneous flaps was similar to that of the surrounding skin, the shape of vulva was natural, the movement of hip joint was not limited, the function of micturition and defecation was not affected, and tumor recurrence was noted in 3 patients.Conclusions:For the complicated large defect after perineum tumor resection, the flexible application of different forms of flaps/myocutaneous flaps to repair according to different areas regains the appearance and function. However, there are many complications, so it is necessary to further strengthen the postoperative care.

On April 11, 2019, a 36-year-old female patient was admitted to Hunan Cancer Hospital. Five years after the modified radical mastectomy for right breast cancer, she planned to undergo scar releasing and reconstruction of right chest wall and free deep inferior epigastric artery perforator (DIEP) flap transfer, right breast reconstruction, and left breast mastopexy. The defect of right chest wall after scar resection was 18 cm×10 cm. During the operation, the vascular pedicle of DIEP flap was accidentally injured, then the profunda artery perforator flap in left inner thigh was designed for salvage. The size of the flap was 20 cm×11 cm, the thickness was 4.5 cm, the length of perforator vessel pedicle was 7.6 cm, and the weight of the flap was 360 g. The right breast defect was repaired with the transferred flap and the deep cavity was filled. The vascular pedicle of profunda artery was anastomosed with the proximal end of the right internal mammary artery. The blood supply of the flap was good during surgery. The left breast mastopexy was completed at the same time, and the donor site of thigh and abdomen was closed directly. The flap survived well and the donor site healed well after surgery. During the follow-up of 7 months post surgery, the appearance and function of thigh donor site were good, no obvious complications were found, and the reconstructed breast was smaller than the contralateral side. This case suggests that the profunda artery perforator flap could be a valuable option as an alternative for DIEP harvesting failure for autologous breast reconstruction.

Objective:To explore the clinical application of bilateral free posteromedial thigh perforator flaps for unilateral breast reconstruction.Methods:Retrospective analysis of bilateral free posteromedial thigh perforator flaps application in six breast cancer cases for immediate or two-staged breast reconstruction. The age of patients ranged from 31 to 47 years old. All cancer occurred in hemi-lateral, 3 cases on left and 3 cases on right. Pathological diagnosis included invasive ductal carcinoma in 3 cases and invasive lobular carcinoma in 3 cases. One or two-staged breast reconstruction using bilateral free posteomedial thigh perforator flaps was carried out in 6 breast cancer patients. In stage Ⅰ cases the breast tumor size ranged from 2.5 to 4.0 cm, (2.8±0.5) cm on average; 3 cases of breast cancer were in stage Ⅰ and 3 cases was in stage Ⅱ. Postoperative follow-up of recipient and donor sites were evaluated.Results:The length of flap was (24.4±0.5) cm, the width of flap was (8.3±0.5) cm, the thickness of flap was (3.4±0.5) cm. The length of pedicle was (8.9±0.4) cm, the outer diameter of pedicle artery was (1.5±0.4) mm, the outer diameter of pedicle vein was (1.9±0.3) mm. The average weight of flap was 235 g (ranged from 165 g to 345 g). Lymphatic leakage occurred in the donor site in 1 case 1 week postoperatively and healed with continuous negative pressure suction in 2 weeks. All flaps survived totally. The reconstructed breasts’ shape, texture and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of thighs was not affected. All 6 patients were followed up for 5-8 months (5.5 months on average) with satisfied result. No local recurrence happened.Conclusions:Bilateral free posteromedial thigh perforator flaps transferring is feasible to reconstruct unilateral breast.