Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap.Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient's QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery.Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0-100)] was better than the rotational group [66.7 (0-100)], (P = 0.020).Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.
Background: Dermal filler injections have been associated with several complications, including migration to other areas and forming nodules due to the presence of foreign bodies or granulomatous reactions may develop, which encapsulates the filler. Fillers might also be associated with malignancy. The presence of such complications must be removed with reconstructive surgery.
Methods: We present a case of breast cancer patient with a history of dermal filler injection to the lower eyelid. The nodules in the lower eyelid was surgically removed, and the lower eyelid, particularly the muscle, was reconstructed to provide a good cosmetic result. The nodules were also pathologically examined to confirm the diagnosis. Reconstruction of the lower eyelid was conducted with care by noting the aesthetic aspects.
Results: A local muscle flap was easy to harvest and handle, and provided good results. It is also important to consider malignancy to treat the patient thoroughly. The pathology examination confirmed the diagnosis of metastasis. This case is unique because the nodules developed in the patient may be associated with metastasis of the cancer or the dermal filler injection.
Conclusion: Our reconstruction technique leads to a good cosmetic result. There are no sign of complications and recurrence at 3 months following the procedure.
Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients' quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect.This is a case series of 11 patients with symptomatic late-stage breast cancers indicated for neoadjuvant chemotherapy and subsequent mastectomy at Dharmais Cancer Hospital. The postmastectomy defect was closed with KPIF and clinical evaluation included flap success rate, percentage of flap necrotic area, and quality of life. There are modifications of the KPIF consisting of the more rounded shape and additional flap movement of the flap's distal lateral ends to the center resembling an "omega" conformation.Mean percentage of flap necrosis area was 9.7% and none of the patients needed additional surgery. The patients' quality of life evaluated using Patient-reported Aesthetic European Organization for Research and Treatment of Cancer (EORTC) Quality of Life, Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life, Questionnaire-Breast Cancer-23-questions (QLQ-BR23) was fair, with sufficiently good scores for global health status and functional scale, and minimal symptomatology burden. The lowest score was for fatigue and financial difficulties parameters from QLQ-C30 and sexual functioning and future perspective from QLQ-BR23.This is a preliminary study to show that a KPIF could be considered as a method for defect-resurfacing reconstruction after mastectomy.
Introduction: Neglected basal cell carcinoma (BCC) of the nose can grow into giant BCCs, rare cases with extensive nasal defects. Such large defects would require complex reconstruction such as free flaps or multiple local flaps. Lateral forehead flap may provide a simpler alternative with good functional and cosmetic results.Case Presentation: We present a case of a 76-year-old man with neglected giant BCC of nose extending to right lower eyelid and upper lip. Wide excision of the tumor leaves a 12cm x 10cm defect. Reconstruction was performed using lateral forehead flap and donor site was covered with split-thickness skin graft from thigh. The second surgery was done after four months to create nostrils and wider eye-opening. Six months later, flap was viable and there was no sign of recurrence. Nasal reconstruction is planned to further improve cosmetics. In this case, neglect is due to low social-economic status and adaptation to painless tumors. The use of lateral forehead flap allows for simpler and faster surgery suitable for elderly. Delayed reconstruction was needed to ensure optimal tissue healing. Conclusions: Neglected BCC causes disfigurement with remarkable morbidity, requiring complex reconstruction. The lateral forehead flap is a simple and reliable reconstruction method for extensive nasal defects with good functional and cosmetic outcomes.
The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.
Osteoarthritis most commonly affects the patellofemoral compartment of the knee, being a major cause of pain and disability. The structural changes that evolve prior to the onset of symptoms can be visualised using magnetic resonance imaging (MRI). There is little known about the role of obesity on the early structural changes in the patella cartilage in younger, asymptomatic adult females.
Objectives
The objective of this study was to examine the relationship between patella cartilage and obesity and change in obesity over the previous 10 years.
Methods
160 asymptomatic women (20-49years) participating in the Geelong Osteoporosis Study underwent knee MRI between 2006-8. Weight and body mass index (BMI) were measured 10 years prior (1994-7, baseline) and at the time of the MRI (current) with change over the period calculated (current-baseline). The relationships between the measures of obesity and patella cartilage volume and defects were examined.
Results
After adjustment for age and patella bone volume, there was a reduction of 13 (95% CI -25.7, -0.55) microliters (mL) in patella cartilage volume for every 1 unit increase in current BMI and reduction of 27mL (95% CI -52.6, -1.5) per BMI unit increase over 10 years (p=0.04 for both). There was no significant association between baseline BMI and patella cartilage volume (p=0.16). Increased baseline and current weight and BMI were associated with increased prevalence of patella cartilage defects (all p<0.001).
Conclusions
Obesity and weight gain over midlife are both associated with detrimental structural change at the patella in young to middle aged healthy women without clinical osteoarthritis. Maintaining a healthy weight, avoiding obesity and weight gain in younger asymptomatic women may be important in the prevention of patellofemoral osteoarthritis.
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