Objective:To explore the strategies and technical points for breast reconstruction using free lower abdominal skin flap transplantation through lateral chest incision.Methods:The data of patients who underwent unilateral breast reconstruction with free lower abdominal flap transplantation using lateral thoracic incision in Hunan Cancer Hospital from October 2022 to March 2023 were retrospectively analyzed. Lateral thoracic incision was used in the recipient area. Firstly suitable radical mastectomy was performed for patients with early onset of breast cancer or recurrence after breast-conserving surgery, and prosthetic dilator removal or breast capsule release was performed for patients with dilator removed or capsular contracture after breast cancer prosthesis reconstruction. After that, the free lower abdominal skin flap breast reconstruction was completed under the same incision. During the operation, blood vessel preparation in the recipient area, skin flap preparation in the donor area, blood vessel anastomosis and breast shaping were completed successively according to the actual situation of the patient. Postoperative observation of complications, follow-up evaluation of reconstructed breast appearance and donor site healing were carred out.Results:A total of 15 female patients were included, aged range from 24 to 57 years old, with an average of 42.3 years old. There were 9 cases of early breast cancer, 2 cases of breast cancer recurrence after breast conserving surgery, 2 cases of breast cancer with dilator removed after breast reconstruction, and 2 cases of capsule contracture after breast cancer prosthesis reconstruction. The length of the lateral chest incision was 7.5-11.2 cm, with an average of 8.7 cm. Six cases were performed with 3/4 of the lower abdominal skin flaps, using a unilateral inferior abdominal vascular pedicle. The volume of the flaps ranged from 19.0 cm × 10.0 cm × 4.5 cm to 23.0 cm × 13.0 cm × 6.0 cm. The weight ranged from 280 to 510 g, with an average of 370 g. Nine cases were performed by cutting the entire lower abdominal skin flap and using bilateral inferior abdominal vascular pedicle. The volume of the skin flaps ranged from 27.0 cm × 11.0 cm × 5.0 cm to 30.0 cm × 14.0 cm × 6.5 cm. The weight ranged from 420 to 730 g, with an average of 530 g. Nine cases were selected as the main trunk of the thoracic and dorsal blood vessels, 4 cases were selected as the anterior serratus branch of the thoracic and dorsal blood vessels, and 2 cases were selected as the main trunk of the thoracic and dorsal blood vessels combined with the anterior serratus branch. One flap experienced venous crisis and the surgery failed, while the remaining 14 flaps survived smoothly. Follow-up period was 6-17 months, with an average of 10.4 months. The reconstructed breast had a satisfactory appearance and texture, without skin flap contraction or deformation. The skin flap donor area and breast recipient area only had linear scars, and there was no significant impact on abdominal wall and shoulder joint function. There was no tumor recurrence or metastasis during follow-up.Conclusion:When the side chest incision is used to perform the related operations of breast cancer radical resection, the free lower abdominal skin flap can be transplanted into the same incision for breast reconstruction. The effect is satisfactory, and the damage of the affected area is further reduced.

Objective:To explore the clinical value and therapeutic effects of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction using an oblique pedicled rectus abdominis myocutaneous flap(ORAMF).Methods:The data of patients admitted to Hunan Cancer Hospital from May to September 2023 who underwent breast cancer resection followed by immediate breast reconstruction with ORAMF were analyzed retrospectively. Surgical methods: firstly, axillary anterior sentinel lymph node biopsy and subcutaneous glandular excision for breast cancer were performed through a lateral chest incision using an endoscopic technique. Subsequently, a unilateral ORAMF was prepared by removing the epidermis and creating subcutaneous tunnels on the surface of the rectus abdominis myocutaneous flap under direct visualization. The subcutaneous tunnel of the flap was then extended to the deep surface of the breast with the assistance of an endoscope, allowing for the transfer of the ORAMF to reconstruct the breast. Post surgery, the flap survival was monitored, and after discharge, patients received enhanced anti-scar treatment and functional rehabilitation exercises. Follow-up assessments included the evaluation of the reconstructed breast shape, incision scarring in both the donor and recipient areas, abdominal wall function, tumor recurrence and metastasis.Results:A total of 8 female patients with unilateral breast cancer were included in this study, aged between 27 and 52 years, with a mean age of 41.7 years old. The body mass index of the patients ranged from 19.1 to 22.5 kg/m 2. All patients had early-stage breast cancer. During the operation the average mass of the resected breast was 245 g(ranging from 220 to 285 g). The length of the lateral thoracotomy incision varied from 6.9 to 9.5 cm, with a mean length of 7.7 cm. In 3 cases, the ipsilateral ORAMF was used for breast reconstruction, while in 5 cases, the contralateral ORAMF was utilized. The dimensions of the flap were as follows: length (20.4±0.7) cm, width (10.8±1.5) cm, thickness (5.4±0.9) cm, with the volume of the flap cutting ranging from 19.7 cm×9.2 cm×4.4 cm to 21.2 cm×11.8 cm×5.9 cm. All of the flaps exhibited good blood supply and survived successfully without the need for additional anastomotic vessels. The patients were followed up for a period of 8 to 10 months post-operation, with an average follow-up of 8.7 months. The reconstructed breasts maintained a good shape and texture, showing no contracture or deformation of the flap, and were generally symmetrical with the healthy breast. The incisions in both the flap donor area and the recipient area had healed well, leaving only linear scars, and the function of the abdominal wall was not significantly compromised. No recurrence or metastasis was observed during the follow-up period. Conclusion:The endoscopic technique helps to preserve the integrity of the breast skin tissue to the greatest extent possible, reducing scarring and assisting in the creation of subcutaneous tunnels to facilitate the transposition of the ORAMF for breast reconstruction. For carefully selected patients with moderately small breasts and ample subcutaneous tissue in the lower abdomen, the preparation of a unilateral ORAMF for breast reconstruction can yield superior results. This approach minimizes additional damage to the donor area, enhancing the safety of the surgery while significantly reducing the complexity of the operation.

Objective:To explore the strategies and technical points for breast reconstruction using free lower abdominal skin flap transplantation through lateral chest incision.Methods:The data of patients who underwent unilateral breast reconstruction with free lower abdominal flap transplantation using lateral thoracic incision in Hunan Cancer Hospital from October 2022 to March 2023 were retrospectively analyzed. Lateral thoracic incision was used in the recipient area. Firstly suitable radical mastectomy was performed for patients with early onset of breast cancer or recurrence after breast-conserving surgery, and prosthetic dilator removal or breast capsule release was performed for patients with dilator removed or capsular contracture after breast cancer prosthesis reconstruction. After that, the free lower abdominal skin flap breast reconstruction was completed under the same incision. During the operation, blood vessel preparation in the recipient area, skin flap preparation in the donor area, blood vessel anastomosis and breast shaping were completed successively according to the actual situation of the patient. Postoperative observation of complications, follow-up evaluation of reconstructed breast appearance and donor site healing were carred out.Results:A total of 15 female patients were included, aged range from 24 to 57 years old, with an average of 42.3 years old. There were 9 cases of early breast cancer, 2 cases of breast cancer recurrence after breast conserving surgery, 2 cases of breast cancer with dilator removed after breast reconstruction, and 2 cases of capsule contracture after breast cancer prosthesis reconstruction. The length of the lateral chest incision was 7.5-11.2 cm, with an average of 8.7 cm. Six cases were performed with 3/4 of the lower abdominal skin flaps, using a unilateral inferior abdominal vascular pedicle. The volume of the flaps ranged from 19.0 cm × 10.0 cm × 4.5 cm to 23.0 cm × 13.0 cm × 6.0 cm. The weight ranged from 280 to 510 g, with an average of 370 g. Nine cases were performed by cutting the entire lower abdominal skin flap and using bilateral inferior abdominal vascular pedicle. The volume of the skin flaps ranged from 27.0 cm × 11.0 cm × 5.0 cm to 30.0 cm × 14.0 cm × 6.5 cm. The weight ranged from 420 to 730 g, with an average of 530 g. Nine cases were selected as the main trunk of the thoracic and dorsal blood vessels, 4 cases were selected as the anterior serratus branch of the thoracic and dorsal blood vessels, and 2 cases were selected as the main trunk of the thoracic and dorsal blood vessels combined with the anterior serratus branch. One flap experienced venous crisis and the surgery failed, while the remaining 14 flaps survived smoothly. Follow-up period was 6-17 months, with an average of 10.4 months. The reconstructed breast had a satisfactory appearance and texture, without skin flap contraction or deformation. The skin flap donor area and breast recipient area only had linear scars, and there was no significant impact on abdominal wall and shoulder joint function. There was no tumor recurrence or metastasis during follow-up.Conclusion:When the side chest incision is used to perform the related operations of breast cancer radical resection, the free lower abdominal skin flap can be transplanted into the same incision for breast reconstruction. The effect is satisfactory, and the damage of the affected area is further reduced.

Objective:To explore the clinical value and therapeutic effects of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction using an oblique pedicled rectus abdominis myocutaneous flap(ORAMF).Methods:The data of patients admitted to Hunan Cancer Hospital from May to September 2023 who underwent breast cancer resection followed by immediate breast reconstruction with ORAMF were analyzed retrospectively. Surgical methods: firstly, axillary anterior sentinel lymph node biopsy and subcutaneous glandular excision for breast cancer were performed through a lateral chest incision using an endoscopic technique. Subsequently, a unilateral ORAMF was prepared by removing the epidermis and creating subcutaneous tunnels on the surface of the rectus abdominis myocutaneous flap under direct visualization. The subcutaneous tunnel of the flap was then extended to the deep surface of the breast with the assistance of an endoscope, allowing for the transfer of the ORAMF to reconstruct the breast. Post surgery, the flap survival was monitored, and after discharge, patients received enhanced anti-scar treatment and functional rehabilitation exercises. Follow-up assessments included the evaluation of the reconstructed breast shape, incision scarring in both the donor and recipient areas, abdominal wall function, tumor recurrence and metastasis.Results:A total of 8 female patients with unilateral breast cancer were included in this study, aged between 27 and 52 years, with a mean age of 41.7 years old. The body mass index of the patients ranged from 19.1 to 22.5 kg/m 2. All patients had early-stage breast cancer. During the operation the average mass of the resected breast was 245 g(ranging from 220 to 285 g). The length of the lateral thoracotomy incision varied from 6.9 to 9.5 cm, with a mean length of 7.7 cm. In 3 cases, the ipsilateral ORAMF was used for breast reconstruction, while in 5 cases, the contralateral ORAMF was utilized. The dimensions of the flap were as follows: length (20.4±0.7) cm, width (10.8±1.5) cm, thickness (5.4±0.9) cm, with the volume of the flap cutting ranging from 19.7 cm×9.2 cm×4.4 cm to 21.2 cm×11.8 cm×5.9 cm. All of the flaps exhibited good blood supply and survived successfully without the need for additional anastomotic vessels. The patients were followed up for a period of 8 to 10 months post-operation, with an average follow-up of 8.7 months. The reconstructed breasts maintained a good shape and texture, showing no contracture or deformation of the flap, and were generally symmetrical with the healthy breast. The incisions in both the flap donor area and the recipient area had healed well, leaving only linear scars, and the function of the abdominal wall was not significantly compromised. No recurrence or metastasis was observed during the follow-up period. Conclusion:The endoscopic technique helps to preserve the integrity of the breast skin tissue to the greatest extent possible, reducing scarring and assisting in the creation of subcutaneous tunnels to facilitate the transposition of the ORAMF for breast reconstruction. For carefully selected patients with moderately small breasts and ample subcutaneous tissue in the lower abdomen, the preparation of a unilateral ORAMF for breast reconstruction can yield superior results. This approach minimizes additional damage to the donor area, enhancing the safety of the surgery while significantly reducing the complexity of the operation.

Purpose/Significance To explore the changes,challenges,key application scenarios and future development directions of generative artificial intelligence(AI)represented by ChatGPT in the field of hospital management,and to provide references for the ap-plication of AI natural language processing(NLP)technology in the field of hospital management in China.Method/Process Through literature review and analysis,the changes and challenges brought about by the rapid development of generative AI in the field of hospital management are sorted out,its key application scenarios and future development directions in the field of hospital management are empha-sized and explored.Result/Conclusion AI has broad application prospects in the field of hospital management,and it should focus on exploring its practical application scenarios and strategic directions to provide reference and guidance for promoting the high-quality de-velopment of public hospitals.

Objective:To investigate the clinical effects of combined tissue flap transplantation in repairing giant chest wall defects.Methods:This study was a retrospective observational study. From August 2013 to December 2020, 31 patients with chest wall tumor or radiation ulcer after radical resection of chest wall tumor and conformed to the inclusion criteria were admitted to the Department of Breast Oncoplastic Surgery of Hunan Cancer Hospital, including 12 males and 19 females, aged 25-71 years. After resection of tumor or ulcer and wound debridement, the area of secondary chest wall defect was 300-600 cm 2 with length of 16-35 cm and width of 16-32 cm. According to the actual situation of the patients and the preoperative design, the chest wall defects were repaired with the flexible combination of perforator flaps and myocutaneous flaps from different donor sites, and the area of the combined tissue flap was 260-540 cm 2 with length of 20-30 cm and width of 13-20 cm. Free posteromedial thigh perforator flap+free anterolateral thigh myocutaneous flap were used in 2 patients, free deep inferior epigastric artery perforator flap+free anterolateral thigh myocutaneous flap were used in 5 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+free anterolateral thigh myocutaneous flap were used in 7 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+pedicled latissimus dorsi myocutaneous flap were used in 2 patients, and bilateral free anterolateral thigh myocutaneous flaps were used in 15 patients. For the remaining small area of superficial tissue defect after being repaired by combined tissue flaps, skin graft was used to repair or delayed local flap transfering was performed after the tissue flaps survived and edema subsided. The appropriate blood vessels in the donor and recipient sites were selected for anastomosis to reconstruct the blood supply of tissue flaps. The wounds in the donor sites of tissue flaps that can be directly sutured were sutured directly; for those that cannot be sutured directly, the skin grafting or delayed suture was performed. The anastomosis of blood vessels in the recipient sites, operation length, and postoperative hospital stay were recorded. The survivals of tissue flaps and skin grafts, the shape and texture of reconstructed chest wall, the wound healing, scar formation, and function of donor sites of tissue flaps, and the scar formation of the donor sites of skin grafts were observed after operation. Tumor recurrence and death of recurrent patients were followed up after operation. Results:The blood vessels in the recipient sites were anastomosed as follows: proximal internal thoracic vessels for 24 times, distal internal thoracic vessels for 12 times, trunk of thoracodorsal vessels for 4 times, anterior serratus branches of thoracodorsal vessels for 8 times, and thoracoacromial vessels for 12 times. The operation length was 6.0 to 8.5 hours, and the postoperative hospital stay was 9 to 21 days. Necrosis at the edge of partial tissue flaps occurred in 4 patients after operation, which healed after dressing change, and the tissue flaps and skin grafts of the other patients survived completely. The shape and texture of the reconstructed chest wall were good. Four patients had poor wound healing in the donor sites of abdominal tissue flaps, which healed after dressing change and local drainage. Only linear scar was left in the donor sites of all tissue flaps, and there was no obvious dysfunction in the donor sites of tissue flaps. Mild hypertrophic scar was left in the donor sites of skin grafts. During follow-up of 9 to 36 months after operation, 6 patients had tumor recurrence, and the recurrence time was 5 to 20 months after operation. After comprehensive treatment for patients with tumor recurrence, 3 patients died.Conclusions:Transplantation of combined tissue flaps in repairing the giant chest wall defects can shorten the time of total operation and hospital stay, and avoid multiple operations. After operation, patients had good chest wall appearance, with reduced tumor recurrence in patients with chest wall tumor.

Objective:To summarize the serious complications and salvage methods and experience of breast reconstruction with free flap transplantation.Methods:Different techniques of free flap transplantation were used for breast reconstruction in 395 breast cancer patients who came to Hunan Cancer Hospital from September 2015 to December 2021. 45 complications occurred during and after surgery, including 21 serious complications. Corresponding salvage method was used for complications and flap failure. Salvage methods included free gracilis myocutaneous flap combined with adductor magnus perforator flap, free adductor magnus perforator flap transplantation, pedicled rectus abdominis flap transplantation, pedicled latissimus dorsi myocutaneous flap, prosthetic replacement, vascular grafting, vascular reanastomosis and release of vascular tension area.Results:The specific causes and salvage methods in 21 cases of reoperation included: 3 cases of excessive tension or compression of vascular pedicle, of which 1 case was successfully salvaged; in 2 cases flap failure was occurred, of which 1 case was replaced with prosthesis, and 1 case was salvaged with free gracilis myocutaneous flap combined with adductor magnus perforator flap; one case of vascular embolism caused by poor quality of vascular anastomosis was successfully salveged by vascular re anastomosis. One case had poor recipient vessels, and the flap failure was salvaged with pedicled latissimus dorsi flap. Three patients had poor compliance, of which one case was successfully salvaged, and the other two cases had total flap failure, which were repaired by free adductor magnus perforator flap and free gracilis myocutaneous flap combined with adductor magnus perforator flap respectively. Two patients had menstrual postoperatively, resulting in flap failure. Free gracilis myocutaneous flap combined with adductor magnus perforator flap and free adductor magnus perforator flap were used for breast reconstruction respectively. In 1 case, the blood supply was affected by excessive flap trimming, and the flap failure was salvaged by free adductor magnus perforator flap. 10 cases of subcutaneous hematoma were treated with debridement and exploration, and all were successfully salvaged.Conclusions:The complications and failure of free flap for breast reconstruction cannot be completely avoided. It is very important to master the corresponding salvage methods.

Objective:To explore the causes of blood supply disorder of the pedicled rectus abdominis flap.Methods:Between January 2019 and May 2021, a cohort of 61 female patients, aged 25 to 70 years with a mean age of (46.9±2.1) years, underwent surgical repair for extensive thoracic wall defects at Hunan Province Cancer Hospital. These defects, resulting from thoracic wall tumor resection, were addressed using a combination of pedicled rectus abdominis myocutaneous flaps and free inferior abdominal artery perforator flaps. The patient cohort included 39 cases of locally advanced breast cancer, 12 cases of recurrent breast cancer, 6 cases of lobular cell sarcoma, and 4 cases of soft tissue sarcoma. The patients were divided into two groups according to the order of revascularization sequence of free inferior abdominal artery perforator flap: 31 cases in the group of anastomosing the artery first and then the accompanying vein (group A), and 30 cases in the group of anastomosing the vein first and then the artery (group B). The main reasons for the blood supply disorders of the pedicled rectus abdominis flap were analysed in the two groups.Results:In all 61 patients, the pedicled rectus abdominis myocutaneous flap showed immediate red and purple plaques and other blood supply disorders. Further anastomosis of the free inferior abdominal wall artery perforating the flap vessel tip was conducted to achieve pressurization. The vascular selection for the recipient area included the intrathoracic vessels in 26 cases, the thoracic acromion vessels in 15 cases, the thoracodorsal vessels in 9 cases, the anterior serratus branch of the thoracodorsal vessels in 7 cases, and the lateral thoracic arteries and veins in 4 cases. The flap length measured (29.1±0.6) cm, while the width of the skin island was (12.9±0.6) cm. The follow-up period was from 9 to 16 months, with a mean of 12.7 months.In the Group A, the flap blood supply was significantly relieved before further anastomosing the vein in 7 cases, and the flap blood supply returned to normal in the other 24 cases after further anastomosing the vein. In the Group B, the flap blood supply was significantly relieved before further anastomosing the artery in 27 cases, and the flap blood supply returned to normal in the other 3 cases after further anastomosing the artery.61 flaps survived completely, the shape of reconstructed chest wall was satisfactory, and there was no flap contracture and deformation; only linear scar was left in the donor area of the flap, and there was no significant effect on the function of the abdominal wall. The patients were followed-up for 9-16 months, with an average of 12.7 months.Conclusions:The main reason for the blood supply obstacle of the rectus abdominis flap is the venous return obstacle, in order to ensure the reliable blood supply of the flap, the venous return should be increased as a priority.

Objective:To investigate the effect of pressurized pedicled rectus abdominis flap for breast reconstruction.Methods:A retrospective study was conducted to include 37 female patients with breast cancer who underwent immediate breast reconstruction using a pressurized pedicle rectus abdominis skin flap transplantation after surgery at the Department of Plastic and Reconstructive Surgery, Hunan Provincial Cancer Hospital from March 2019 to December 2022. The patients were aged 29-61 years, with an average age of (37.7±3.5) years. According to the preoperative imaging and ultrasound data, 17 patients were planned to complete immediate breast reconstruction with free inferior abdominal artery perforator flap transplantation, and the operation was adjusted to directly prepare a pedicled rectus abdominis flap with long inferior abdominal vessel pedicle according to the actual situation. In addition, 20 patients were scheduled to use pedicled rectus abdominis flap alone, and the operation was changed according to the actual situation. The flap was trimmed according to the condition of the affected area and immediate intraoperative fluorgraphy. After cutting off the vascular pedicle, the recipient area was placed, and the recipient blood vessels were selected for vascular anastomosis. After shaping, the donor and recipient areas were sutured. The survival of the skin flap was observed.Results:Intraoperative fluorescein angiography was used to determine the blood supply of the flap. It was found that 37 cases of pedicled rectus abdominis flaps had different degrees of blood supply disorders. The affected vessels in the specific anastomosis comprised the intrathoracic vessels (19 cases, 51.4%), the lateral thoracic arterial vein (10 cases, 27.0%), and anterior branches of the thoracic and dorsal vessels (8 cases, 21.6%). In 37 cases, the lateral abdominal wall vein was carried in the flap, 20 of which carried the lateral abdominal wall shallow vein, 17 cases carried the lateral abdominal wall shallow vein, six of which were extra anastomosed and superficial vein, and the actual utilization rate was 16.2%. The follow-up was 47 months, averaging 22.7 months. 37 patients had fair reconstructed breast appearance, good elasticity, and no flap contracture deformation. Only linear scar was left in the flap donor area with no effect on abdominal wall function.Conclusions:Pressurized rectus flap can improve the survival rate and surgical safety.

OBJECTIVE: To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. METHODS: Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. RESULTS: All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). CONCLUSION The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
Male ; Female ; Humans ; Adult ; Myocutaneous Flap/surgery* ; Plastic Surgery Procedures ; Thoracic Wall/surgery* ; Rectus Abdominis/transplantation* ; Skin Transplantation ; Breast Neoplasms/surgery* ; Soft Tissue Injuries/surgery* ; Treatment Outcome