- Email: [email protected]
Regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction
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Regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction
Correspondence and communications 4. Caulfield RH, Maleki-Tabrizi A, Mathur B, Ramakrishnan V. Salvage of a DIEP flap using a retrograde flow anastomosis. J Plast Reconstr Aesthet Surg 2008;61(3):346e7.
Kamil Asaad Richard P. Cole Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire SP2 8BJ, UK E-mail address: [email protected]
Dear Sir, We read with great interest the letter from Chaput et al.1 regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction. The national comparative audit of mastectomy and breast reconstruction surgery in England 2 included 476 cases of immediate free flap breast reconstruction and 566 cases of delayed free flap breast reconstruction. The overall free flap failure rate was 1.98%. In our own department the total failure rate is 0.48% for free flap breast reconstruction (unpublished data). Chaput et al.1 reported a significantly higher flap failure rate of 19% using this technique, although Santanelli di Pompeo3 reports a much higher success rate. We have not adopted this technique in our department, but broadly agree with the advantages and disadvantages previously proposed.1 We feel that this pedicle may have value in a salvage scenario, as reported by Caulfield et al.4 However, we would only adopt it with caution based on these contrasting reports. Yours sincerely.
Conflict of interest None.
Funding N/A.
Ethical approval N/A.
References 1. Chaput B, Garrido I, Bekara F, Gangloff D, Meresse T, Grolleau JL. Serratus anterior muscle pedicle as the recipient site in DIEP flap transfer for breast reconstruction: why not the first choice? J Plast Reconstr Aesthet Surg 2014;67(12): 1758e60. 2. Jeevan R, Cromwell DA, Browne JP, et al. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg 2014;67(10): 1333e44. 3. Santanelli di Pompeo F, Longo B, Laporta R, Pagnoni M, Cavalieri E. The use of the serratus anterior muscle vascular pedicle as recipient site in DIEP flap transfer for breast reconstruction. J Plast Reconstr Aesthet Surg 2014;67(4): 456e60.
DOI of original j.bjps.2014.07.028
article:
http://dx.doi.org/10.1016/
ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. http://dx.doi.org/10.1016/j.bjps.2015.03.007
Re: ‘Combined clearance of pelvic and superficial nodes for clinical groin melanoma’ Dear Sir, Regarding: West C.A. et al. Combined clearance of pelvic and superficial nodes for clinical groin melanoma. We read with great interest the paper by West, Saleh and Peach1 and we strongly agree with their recommendation in advocating ‘ILND in all patients with a clinically evident melanoma in a single groin node.’ The advantage is clearly demonstrated by the group’s finding that 42% of the series had positive pelvic nodes, and that 43% of pelvic nodes were radiologically occult. Overall survival seems favourable, with a mean of 2.63 years.1 They cited 5-year survival figures from the literature of 24e35% following the procedure, which is comparable with our unit’s previously published data of 28% and 51% respectively for patients with metastatic inguinal and pelvic nodes, and inguinal nodal metastasis only (P Z 0.002).2 We note their reported mean inpatient stay of 10.2 days (SD 5.95, median 8.0 days, range 4e34 days), (albeit with a note in the discussion allowing for evolving practice reducing this mean to ‘ . just 8.8 days’).1 Our practice at the Royal Marsden Hospital has been to place two drains at the time of surgery, one superficially in the groin and one deep in the pelvis. We remove the pelvic drain by postoperative day 2, introduce early physiotherapy and mobilisation, and allow patients home with the superficial drain in situ. This enables early discharge: in 16 patients who underwent ilio-inguinal block dissection at our institution in 2014 the mean inpatient stay was 4.75 days, median 5 days (range 3e8 days). In terms of morbidity our unit has found a similar rate of post-operative problems. The rate of surgical site infection
Regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction
Correspondence and communications 4. Caulfield RH, Maleki-Tabrizi A, Mathur B, Ramakrishnan V. Salvage of a DIEP flap using a retrograde flow anastomosis. J Plast Reconstr Aesthet Surg 2008;61(3):346e7.
Kamil Asaad Richard P. Cole Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire SP2 8BJ, UK E-mail address: [email protected]
Dear Sir, We read with great interest the letter from Chaput et al.1 regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction. The national comparative audit of mastectomy and breast reconstruction surgery in England 2 included 476 cases of immediate free flap breast reconstruction and 566 cases of delayed free flap breast reconstruction. The overall free flap failure rate was 1.98%. In our own department the total failure rate is 0.48% for free flap breast reconstruction (unpublished data). Chaput et al.1 reported a significantly higher flap failure rate of 19% using this technique, although Santanelli di Pompeo3 reports a much higher success rate. We have not adopted this technique in our department, but broadly agree with the advantages and disadvantages previously proposed.1 We feel that this pedicle may have value in a salvage scenario, as reported by Caulfield et al.4 However, we would only adopt it with caution based on these contrasting reports. Yours sincerely.
Conflict of interest None.
Funding N/A.
Ethical approval N/A.
References 1. Chaput B, Garrido I, Bekara F, Gangloff D, Meresse T, Grolleau JL. Serratus anterior muscle pedicle as the recipient site in DIEP flap transfer for breast reconstruction: why not the first choice? J Plast Reconstr Aesthet Surg 2014;67(12): 1758e60. 2. Jeevan R, Cromwell DA, Browne JP, et al. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg 2014;67(10): 1333e44. 3. Santanelli di Pompeo F, Longo B, Laporta R, Pagnoni M, Cavalieri E. The use of the serratus anterior muscle vascular pedicle as recipient site in DIEP flap transfer for breast reconstruction. J Plast Reconstr Aesthet Surg 2014;67(4): 456e60.
DOI of original j.bjps.2014.07.028
article:
http://dx.doi.org/10.1016/
ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. http://dx.doi.org/10.1016/j.bjps.2015.03.007
Re: ‘Combined clearance of pelvic and superficial nodes for clinical groin melanoma’ Dear Sir, Regarding: West C.A. et al. Combined clearance of pelvic and superficial nodes for clinical groin melanoma. We read with great interest the paper by West, Saleh and Peach1 and we strongly agree with their recommendation in advocating ‘ILND in all patients with a clinically evident melanoma in a single groin node.’ The advantage is clearly demonstrated by the group’s finding that 42% of the series had positive pelvic nodes, and that 43% of pelvic nodes were radiologically occult. Overall survival seems favourable, with a mean of 2.63 years.1 They cited 5-year survival figures from the literature of 24e35% following the procedure, which is comparable with our unit’s previously published data of 28% and 51% respectively for patients with metastatic inguinal and pelvic nodes, and inguinal nodal metastasis only (P Z 0.002).2 We note their reported mean inpatient stay of 10.2 days (SD 5.95, median 8.0 days, range 4e34 days), (albeit with a note in the discussion allowing for evolving practice reducing this mean to ‘ . just 8.8 days’).1 Our practice at the Royal Marsden Hospital has been to place two drains at the time of surgery, one superficially in the groin and one deep in the pelvis. We remove the pelvic drain by postoperative day 2, introduce early physiotherapy and mobilisation, and allow patients home with the superficial drain in situ. This enables early discharge: in 16 patients who underwent ilio-inguinal block dissection at our institution in 2014 the mean inpatient stay was 4.75 days, median 5 days (range 3e8 days). In terms of morbidity our unit has found a similar rate of post-operative problems. The rate of surgical site infection