- Email: [email protected]
433. Postoperative rectourethral fistulas: A single center experience of a challenging clinical entity
ABSTRACTS
S165
Anastomotic leakage was the main reason for reoperation in these patients (83.3%). In patients with severe muscle depletion, there was a trend towards a significantly increased incidence of anastomotic leakage (46% vs. 20%, p ¼ 0.06). After a median follow-up of 30 months, 43 patients (34%) had deceased, resulting in a median overall survival of 38.5 months. Preoperative severe muscle depletion was not significantly associated with overall and disease-free survival (p ¼ 0.57 and p ¼ 0.62). Conclusions: In patients treated with CRS+HIPEC for peritonitis carcinomatosis of colorectal cancer, severe skeletal muscle depletion is associated with an increased rate of reoperation. Therefore, L3 muscle assessment may be a valuable preoperative tool to predict postoperative morbidity. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.420 431. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies: Analysis of the causes of disqualification J. Mielko1, M. Sk orzewska1, B. Cisel1, J. Romanek1, M. Lewicka1, R. 1 Sitarz , W. Budny1, A. Kurylcio1, W.P. Polkowski1 1 Medical University of Lublin, Department of Surgical Oncology, Lublin, Poland The combination of maximal cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may improve the oncological outcome of highly selected patients (limited peritoneal carcinomatosis; PC) with peritoneal surface malignancies. The purpose of this study is to analyse of the causes of disqualification from the HIPEC. Materials and methods: Between November 2010 and March 2014, 114 patients were qualified to the operative treatment (CRS+HIPEC). The origin of PC was ovarian cancer (n ¼ 50, 43%), colorectal cancer (n ¼ 26, 23%) pseudomyxoma peritonei (n ¼ 23, 20%), gastric cancer (n ¼ 8, 7%), mesothelioma (n ¼ 3, 3%), pancreatic cancer (n ¼ 2, 2%), primary cancers of peritoneum (2, 2%). Fifty nine patients were treated with the CRS+HIPEC 69 times. Eight patients underwent iterative CRS+HIPEC procedures for isolated recurrent peritoneal disease. After exploration at laparotomy and quantitation of the PC index (PCI), 55 (48%) patients were disqualified from the HIPEC. Results: The reason of disqualification of 34 (61%) patients were the advanced tumour stage (PCI > 20) with involvement of large vessels, massive infiltration of the small intestine and mesentery, hepatoduodenal ligament invasion and lack of possibility for the CRS. Eight (15%) patients were treated palliatively (CCR 3) without HIPEC due to the intestinal obstruction and ileus. Six (10%) patients had nodal recurrence without evidence of PC. Six (10%) patients had no macroscopic signs of PC. In three of these patients microscopic PC was found after final pathological examination, and HIPEC was performed in a second stage. The reason of the CRS+HIPEC disqualification of three patients were non-resectable liver metastases. In two cases due to the cardiac disorders and hemodynamic instability during CRS, the HIPEC was not applied. In two cases the HIPEC treatment was postponed to the next stage due to the multi-organ resections (over 5 organs). Bilateral obstructing infiltration in the ureters with hydronephrosis, advanced retroperitoneal infiltration caused disqualification of further 4 patients. Conclusions: The most common reason of the HIPEC treatment disqualification is advanced tumour stage which makes the complete
cytoreduction (CCR0/1) impossible. In order to apply the HIPEC safely, the surgical procedure may be divided into two stages. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.421
432. Intraperitoneal chemotherapy for epithelial ovarian cancer: Indian experience K. Ashwin1 1 Manipal Comprehensive Cancer Center, Surgical Oncology, Bangalore, India Introduction: Ovarian cancer tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal chemotherapy. Materials and methods: 168 patients with stage III ovarian cancer were randomized into intravenous chemotherapy group (IV group) or intraperitoneal chemotherapy group (IP group). All patients underwent optimal cytoreduction & those in IP group had intraperitoneal chemoport insertion. The IV group chemotherapy regimen was IV Paclitaxel 175 Mg/ m2 as a 3 hour infusion followed by IV carboplatin on day 1. The IP chemotherapy regimen consisted of day 1 e paclitaxel IV (135 mg/m2 over 3 hrs), day 2 ecisplatin (75 mg/m2) and on day 8 epaclitaxel IP (60 mg/m2). The aim of the study was to compare the recurrence free survival, overall survival and toxicity between IV group and IP group. Results: On comparing the toxicity profile statistical significance was noted for grade 3e4 abdominal pain for IP chemotherapy patients (P value 0.07). Other variables like fatigue, infection, haemotoxicity, neurotoxicity, gastrointestinal and metabolic complications did not achieve statistical significance (P values 0.74, 0.49, 0.52, 1.0, 0.64 and 0.64 respectively). The most common toxicity associated with IP chemotherapy instillation were port related complications (21.42%) followed by haematotoxicity and fatigue (17.9% in each). Peritoneum was the most common site of recurrence. Recurrence was seen in 12 (14.28%) in IP group and 30 (35.71%) in IV group, which was statistically significant, P ¼ 0.024 by Chi Square test. The median time to recurrence in IP and IV chemotherapy groups were 11.8 & 21.4 months respectively. The time to recurrence was statistically significant in intravenous chemotherapy patients as compared with, IP chemotherapy patients. (P value 0.001) according to Log Rank test. The median survival time was 17 and 20 months for the IP and IV chemotherapy arms respectively. The OS was not significantly different between the groups by Mann Whitney U test, p ¼ 0.175. Conclusion: IP chemotherapy can be safely given in stage III optimally cytoreduced ovarian cancer patients. Study showed statistically significant benefit in terms of RFS but the OS was not statistically different. The IP chemotherapy is well tolerated by Indian patients and with meticulous technique and modified IP chemotherapy regimen the complications can be drastically reduced. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.422
Poster Session: Plastic and Reconstructive Surgery 433. Postoperative rectourethral fistulas: A single center experience of a challenging clinical entity A. Dellis1, G. Polymeneas1, L. Samanidis1, T. Theodosopoulos1, I. Papaconstantinou1, T. Manousakas1, A. Gravanis1, D. Voros1 1 Aretaieion Hospital University of Athens, B’ Surgical Clinic, Athens, Greece
Background: Rectourethral fistulas, especially the ones resulting from radical prostatectomy, radiotherapy or combinations, although rare, are serious and difficult surgical problems, challenging experts with their surgical management. Herein, we present our experience of five patients with urethrorectal fistulas.
S166 Material and methods: From June 1998 until September 2012 we performed surgical repair of urethrorectal fistulas in 5 male patients. Mean patient age was 50.4 years (range 18 to 68). Mean follow-up is 47 months (range 13 to 168). Etiology was rectal injury during radical retropubic prostatectomy elsewhere in 3 patients, low anterior resection due to rectal cancer in one patient and anal reconstruction due to low anorectal malformation treated on the second postnatal day in one patient. All patients suffered urethrorectal fistulas and four were offered suprapubic cystostomy, while four patients underwent initially transperineal fistula ligation. In two patients due to fistula relapse we performed anal plug placement, while in one of them after second fistula relapse, we performed gracilis muscle flap translocation, four years after the first reconstructive operation. Results: Two patients had full continuity of the urinary and gastrointestinal tract, being urine and fecal continent as well. In the third patient, two years after radical prostatectomy, we used an anal plug due to fistula relapse. The patient suffers from rare and minor episodes of pneumaturia. In the fourth patient, after the gracilis muscle flap translocation, he remains continent without urinary tract infections or pneumaturia. The fifth patient who underwent anorectal reconstruction on second neonatal day and was initially treated with transanal advancement flap repair, he had finally undergone scrotal flap translocation. No episodes of de novo urinary or fecal incontinence occurred in any of our patients. Conclusions: The majority of rectourethral fistulas can be managed using proper surgical techniques with high success rates in experienced hands with preservation of urinary and bowel function. We emphasize the double diversion before attempting major reconstruction. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.423
435. Muscle, myocutaneous and perforator flaps for reconstruction after abdominoperineal resection (APR) surgery: Our recent clinical experience M. Fraccalvieri1, S. Sandrucci2, M. Morino3, M. Salomone1, E. Falleto3, M. Mistrangelo3, U. Morozzo1, S. Bruschi1 1 Ospedale S. Giovanni Battista Molinette, Plastic Surgery, Torino, Italy 2 Ospedale S. Giovanni Battista Molinette, Surgical Oncology, Torino, Italy 3 Ospedale S. Giovanni Battista Molinette, General Surgery, Torino, Italy Background: After abdomino-perineal resection (APR) the optimal treatment must provide a safe and durable coverage together with the obliteration of dead spaces, on the contrary you can predispose to postoperative complications, including wound breakdown, site infection and perineal herniation. The preferred flaps for perineal defects are traditionally the vertical rectus abdominis myocutaneous (VRAM) and gracilis flaps and more recently gluteus maximus flaps sometimes in conjunction with fasciocutaneous buttock rotation perforator flaps. Material and methods: Since November 2013 in our University Hospital, Plastic and General Surgeons cooperated in performing both primary or delayed reconstructive surgery following APR: author’s choice was to perform muscle flaps, sometimes combined with perforator fasciocutaneous flaps, or directly myocutaneous flaps (planned on gracilis or the bilateral advanced V-Y myocutaneous glutes flap). A total of 5 patients were treated in this study, three females and two males, with an average of 50 years old. The average wound dimension volume was 10 10 15 cm. Results: Only one patient suffered from wound dehiscence (fasciocutaneous portion of the flap), that healed completely in 15 days after minor surgical revision under local anesthesia. Conclusions: In Author’s opinion primary intention wound closure should always be considered as first line strategy. When the wound to fill in is more anterior we prefer employing gracilis muscle flap, mono or bilateral; when the loss of tissue is more posterior we prefer fasciocutaneous perforator flap, monolateral or bilateral, in conjunction with medial part of gluteus maximus muscle flap ( mono-or bilateral). In case of sacrectomy we usually employ mono or bilateral advanced V-Y muscolo.
ABSTRACTS No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.424
436. Preserved areolar skin after skin-sparing mastectomy provides increased sensation in the reconstructed nipple areolar complex I. Do Vale1, S.L. Rayne2, G. Manyangadze4, C.A. Benn2, J.S. Slabbert3, M. Venter3, L.C.J. Serrurier3 1 Faculty of Health Sciences University of the Witwatersrand, Department of Plastic and Reconstructive Surgery, Johannesburg, South Africa 2 Faculty of Health Sciences University of the Witwatersrand, Department of Surgery, Johannesburg, South Africa 3 Netcare Milpark Hospital, Netcare Breast Care Centre, Johannesburg, South Africa 4 Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa Background: Nipple areolar complex reconstruction (NACR) is the final stage of breast reconstruction that transforms the surgically created breast mound into a more natural-looking breast facsimile, using local or distant tissue. Its aim is only to restore aesthetic integrity and sensation is usually impaired which disappoints many patients. A new technique of sparing areolar skin at the time of skin-sparing mastectomy (SSM) can be used with this areolar tissue used then to reconstruct the nipple. The benefit to nipple sensation of this technique is unknown and the aim of this study is to determine the effect of areolar skin preservation on nipple sensation after Areolar-skin Preserved NACR (A-PNACR) compared to traditional methods of NACR. Material and methods: This was a prospective study of patients who underwent NACR between 2009 and 2013 in one unit. The study groups comprised patients who had undergone bilateral NACR using preserved areolar skin and full-thickness skin graft (FTSG), following SSM with areolar-skin preservation. The control group comprised patients with NACR from chest wall skin and FTSG after mastectomy and expanderprostheses reconstruction. Skin sensation was determined by light touch using a cotton swab and sensation using a Semmes-Weinstein monofilament kit exerting between 0.07 g and 300 g pressure. Sensation was tested in four quadrants of each nipple and each areolar (8 patient test-areas (PTA) per patient) using the suprasternal notch as control. Minimum grams of pressure resulting in sensation were recorded for each area. Results: 29 patients were recruited, 18 in study group (A-PNACR) and 11 as control. The groups were well-matched for age and time since final surgery. Nipple reconstruction used either a Maltese cross (8 study, 11 control) or double opposing tab (10 study, 0 control; p ¼ 0.002). Pressure sensation was highly significantly increased in patients with AP NACR with sensitivity to 0.07 g found in 12 PTA and to 0.4 g in 17 PTA. No sensitivity to 0.07 g or 0.4 g was found in the control group (p < 0.00001). Far fewer A-PNACR patients had very poor (300 g) or absent nipple sensation (50 PTA vs 74 PTA; p < 0.0001). Light touch was diminished in both groups although better in A-P NACR (11.1% vs 4.8%; NS). Conclusion: This study confirms that an areolar-skin preserved NACR confers significantly better nipple sensation for patients post-operatively than conventional techniques of NACR. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.425
437. Evaluation of patients’ knowledge, desire and psychosocial background in decision-making regarding postmastectomy breast reconstruction in Hungary: A questionnaire study of 500 cases M. Ujhelyi1, A. Savolt1, D. Pukancsik1, A. Bartal2, I. Kenessey3, Z. Matrai1 1 National Institute of Oncology, Breast and Sarcoma Surgery, Budapest, Hungary
S165
Anastomotic leakage was the main reason for reoperation in these patients (83.3%). In patients with severe muscle depletion, there was a trend towards a significantly increased incidence of anastomotic leakage (46% vs. 20%, p ¼ 0.06). After a median follow-up of 30 months, 43 patients (34%) had deceased, resulting in a median overall survival of 38.5 months. Preoperative severe muscle depletion was not significantly associated with overall and disease-free survival (p ¼ 0.57 and p ¼ 0.62). Conclusions: In patients treated with CRS+HIPEC for peritonitis carcinomatosis of colorectal cancer, severe skeletal muscle depletion is associated with an increased rate of reoperation. Therefore, L3 muscle assessment may be a valuable preoperative tool to predict postoperative morbidity. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.420 431. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies: Analysis of the causes of disqualification J. Mielko1, M. Sk orzewska1, B. Cisel1, J. Romanek1, M. Lewicka1, R. 1 Sitarz , W. Budny1, A. Kurylcio1, W.P. Polkowski1 1 Medical University of Lublin, Department of Surgical Oncology, Lublin, Poland The combination of maximal cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may improve the oncological outcome of highly selected patients (limited peritoneal carcinomatosis; PC) with peritoneal surface malignancies. The purpose of this study is to analyse of the causes of disqualification from the HIPEC. Materials and methods: Between November 2010 and March 2014, 114 patients were qualified to the operative treatment (CRS+HIPEC). The origin of PC was ovarian cancer (n ¼ 50, 43%), colorectal cancer (n ¼ 26, 23%) pseudomyxoma peritonei (n ¼ 23, 20%), gastric cancer (n ¼ 8, 7%), mesothelioma (n ¼ 3, 3%), pancreatic cancer (n ¼ 2, 2%), primary cancers of peritoneum (2, 2%). Fifty nine patients were treated with the CRS+HIPEC 69 times. Eight patients underwent iterative CRS+HIPEC procedures for isolated recurrent peritoneal disease. After exploration at laparotomy and quantitation of the PC index (PCI), 55 (48%) patients were disqualified from the HIPEC. Results: The reason of disqualification of 34 (61%) patients were the advanced tumour stage (PCI > 20) with involvement of large vessels, massive infiltration of the small intestine and mesentery, hepatoduodenal ligament invasion and lack of possibility for the CRS. Eight (15%) patients were treated palliatively (CCR 3) without HIPEC due to the intestinal obstruction and ileus. Six (10%) patients had nodal recurrence without evidence of PC. Six (10%) patients had no macroscopic signs of PC. In three of these patients microscopic PC was found after final pathological examination, and HIPEC was performed in a second stage. The reason of the CRS+HIPEC disqualification of three patients were non-resectable liver metastases. In two cases due to the cardiac disorders and hemodynamic instability during CRS, the HIPEC was not applied. In two cases the HIPEC treatment was postponed to the next stage due to the multi-organ resections (over 5 organs). Bilateral obstructing infiltration in the ureters with hydronephrosis, advanced retroperitoneal infiltration caused disqualification of further 4 patients. Conclusions: The most common reason of the HIPEC treatment disqualification is advanced tumour stage which makes the complete
cytoreduction (CCR0/1) impossible. In order to apply the HIPEC safely, the surgical procedure may be divided into two stages. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.421
432. Intraperitoneal chemotherapy for epithelial ovarian cancer: Indian experience K. Ashwin1 1 Manipal Comprehensive Cancer Center, Surgical Oncology, Bangalore, India Introduction: Ovarian cancer tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal chemotherapy. Materials and methods: 168 patients with stage III ovarian cancer were randomized into intravenous chemotherapy group (IV group) or intraperitoneal chemotherapy group (IP group). All patients underwent optimal cytoreduction & those in IP group had intraperitoneal chemoport insertion. The IV group chemotherapy regimen was IV Paclitaxel 175 Mg/ m2 as a 3 hour infusion followed by IV carboplatin on day 1. The IP chemotherapy regimen consisted of day 1 e paclitaxel IV (135 mg/m2 over 3 hrs), day 2 ecisplatin (75 mg/m2) and on day 8 epaclitaxel IP (60 mg/m2). The aim of the study was to compare the recurrence free survival, overall survival and toxicity between IV group and IP group. Results: On comparing the toxicity profile statistical significance was noted for grade 3e4 abdominal pain for IP chemotherapy patients (P value 0.07). Other variables like fatigue, infection, haemotoxicity, neurotoxicity, gastrointestinal and metabolic complications did not achieve statistical significance (P values 0.74, 0.49, 0.52, 1.0, 0.64 and 0.64 respectively). The most common toxicity associated with IP chemotherapy instillation were port related complications (21.42%) followed by haematotoxicity and fatigue (17.9% in each). Peritoneum was the most common site of recurrence. Recurrence was seen in 12 (14.28%) in IP group and 30 (35.71%) in IV group, which was statistically significant, P ¼ 0.024 by Chi Square test. The median time to recurrence in IP and IV chemotherapy groups were 11.8 & 21.4 months respectively. The time to recurrence was statistically significant in intravenous chemotherapy patients as compared with, IP chemotherapy patients. (P value 0.001) according to Log Rank test. The median survival time was 17 and 20 months for the IP and IV chemotherapy arms respectively. The OS was not significantly different between the groups by Mann Whitney U test, p ¼ 0.175. Conclusion: IP chemotherapy can be safely given in stage III optimally cytoreduced ovarian cancer patients. Study showed statistically significant benefit in terms of RFS but the OS was not statistically different. The IP chemotherapy is well tolerated by Indian patients and with meticulous technique and modified IP chemotherapy regimen the complications can be drastically reduced. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.422
Poster Session: Plastic and Reconstructive Surgery 433. Postoperative rectourethral fistulas: A single center experience of a challenging clinical entity A. Dellis1, G. Polymeneas1, L. Samanidis1, T. Theodosopoulos1, I. Papaconstantinou1, T. Manousakas1, A. Gravanis1, D. Voros1 1 Aretaieion Hospital University of Athens, B’ Surgical Clinic, Athens, Greece
Background: Rectourethral fistulas, especially the ones resulting from radical prostatectomy, radiotherapy or combinations, although rare, are serious and difficult surgical problems, challenging experts with their surgical management. Herein, we present our experience of five patients with urethrorectal fistulas.
S166 Material and methods: From June 1998 until September 2012 we performed surgical repair of urethrorectal fistulas in 5 male patients. Mean patient age was 50.4 years (range 18 to 68). Mean follow-up is 47 months (range 13 to 168). Etiology was rectal injury during radical retropubic prostatectomy elsewhere in 3 patients, low anterior resection due to rectal cancer in one patient and anal reconstruction due to low anorectal malformation treated on the second postnatal day in one patient. All patients suffered urethrorectal fistulas and four were offered suprapubic cystostomy, while four patients underwent initially transperineal fistula ligation. In two patients due to fistula relapse we performed anal plug placement, while in one of them after second fistula relapse, we performed gracilis muscle flap translocation, four years after the first reconstructive operation. Results: Two patients had full continuity of the urinary and gastrointestinal tract, being urine and fecal continent as well. In the third patient, two years after radical prostatectomy, we used an anal plug due to fistula relapse. The patient suffers from rare and minor episodes of pneumaturia. In the fourth patient, after the gracilis muscle flap translocation, he remains continent without urinary tract infections or pneumaturia. The fifth patient who underwent anorectal reconstruction on second neonatal day and was initially treated with transanal advancement flap repair, he had finally undergone scrotal flap translocation. No episodes of de novo urinary or fecal incontinence occurred in any of our patients. Conclusions: The majority of rectourethral fistulas can be managed using proper surgical techniques with high success rates in experienced hands with preservation of urinary and bowel function. We emphasize the double diversion before attempting major reconstruction. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.423
435. Muscle, myocutaneous and perforator flaps for reconstruction after abdominoperineal resection (APR) surgery: Our recent clinical experience M. Fraccalvieri1, S. Sandrucci2, M. Morino3, M. Salomone1, E. Falleto3, M. Mistrangelo3, U. Morozzo1, S. Bruschi1 1 Ospedale S. Giovanni Battista Molinette, Plastic Surgery, Torino, Italy 2 Ospedale S. Giovanni Battista Molinette, Surgical Oncology, Torino, Italy 3 Ospedale S. Giovanni Battista Molinette, General Surgery, Torino, Italy Background: After abdomino-perineal resection (APR) the optimal treatment must provide a safe and durable coverage together with the obliteration of dead spaces, on the contrary you can predispose to postoperative complications, including wound breakdown, site infection and perineal herniation. The preferred flaps for perineal defects are traditionally the vertical rectus abdominis myocutaneous (VRAM) and gracilis flaps and more recently gluteus maximus flaps sometimes in conjunction with fasciocutaneous buttock rotation perforator flaps. Material and methods: Since November 2013 in our University Hospital, Plastic and General Surgeons cooperated in performing both primary or delayed reconstructive surgery following APR: author’s choice was to perform muscle flaps, sometimes combined with perforator fasciocutaneous flaps, or directly myocutaneous flaps (planned on gracilis or the bilateral advanced V-Y myocutaneous glutes flap). A total of 5 patients were treated in this study, three females and two males, with an average of 50 years old. The average wound dimension volume was 10 10 15 cm. Results: Only one patient suffered from wound dehiscence (fasciocutaneous portion of the flap), that healed completely in 15 days after minor surgical revision under local anesthesia. Conclusions: In Author’s opinion primary intention wound closure should always be considered as first line strategy. When the wound to fill in is more anterior we prefer employing gracilis muscle flap, mono or bilateral; when the loss of tissue is more posterior we prefer fasciocutaneous perforator flap, monolateral or bilateral, in conjunction with medial part of gluteus maximus muscle flap ( mono-or bilateral). In case of sacrectomy we usually employ mono or bilateral advanced V-Y muscolo.
ABSTRACTS No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.424
436. Preserved areolar skin after skin-sparing mastectomy provides increased sensation in the reconstructed nipple areolar complex I. Do Vale1, S.L. Rayne2, G. Manyangadze4, C.A. Benn2, J.S. Slabbert3, M. Venter3, L.C.J. Serrurier3 1 Faculty of Health Sciences University of the Witwatersrand, Department of Plastic and Reconstructive Surgery, Johannesburg, South Africa 2 Faculty of Health Sciences University of the Witwatersrand, Department of Surgery, Johannesburg, South Africa 3 Netcare Milpark Hospital, Netcare Breast Care Centre, Johannesburg, South Africa 4 Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa Background: Nipple areolar complex reconstruction (NACR) is the final stage of breast reconstruction that transforms the surgically created breast mound into a more natural-looking breast facsimile, using local or distant tissue. Its aim is only to restore aesthetic integrity and sensation is usually impaired which disappoints many patients. A new technique of sparing areolar skin at the time of skin-sparing mastectomy (SSM) can be used with this areolar tissue used then to reconstruct the nipple. The benefit to nipple sensation of this technique is unknown and the aim of this study is to determine the effect of areolar skin preservation on nipple sensation after Areolar-skin Preserved NACR (A-PNACR) compared to traditional methods of NACR. Material and methods: This was a prospective study of patients who underwent NACR between 2009 and 2013 in one unit. The study groups comprised patients who had undergone bilateral NACR using preserved areolar skin and full-thickness skin graft (FTSG), following SSM with areolar-skin preservation. The control group comprised patients with NACR from chest wall skin and FTSG after mastectomy and expanderprostheses reconstruction. Skin sensation was determined by light touch using a cotton swab and sensation using a Semmes-Weinstein monofilament kit exerting between 0.07 g and 300 g pressure. Sensation was tested in four quadrants of each nipple and each areolar (8 patient test-areas (PTA) per patient) using the suprasternal notch as control. Minimum grams of pressure resulting in sensation were recorded for each area. Results: 29 patients were recruited, 18 in study group (A-PNACR) and 11 as control. The groups were well-matched for age and time since final surgery. Nipple reconstruction used either a Maltese cross (8 study, 11 control) or double opposing tab (10 study, 0 control; p ¼ 0.002). Pressure sensation was highly significantly increased in patients with AP NACR with sensitivity to 0.07 g found in 12 PTA and to 0.4 g in 17 PTA. No sensitivity to 0.07 g or 0.4 g was found in the control group (p < 0.00001). Far fewer A-PNACR patients had very poor (300 g) or absent nipple sensation (50 PTA vs 74 PTA; p < 0.0001). Light touch was diminished in both groups although better in A-P NACR (11.1% vs 4.8%; NS). Conclusion: This study confirms that an areolar-skin preserved NACR confers significantly better nipple sensation for patients post-operatively than conventional techniques of NACR. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.425
437. Evaluation of patients’ knowledge, desire and psychosocial background in decision-making regarding postmastectomy breast reconstruction in Hungary: A questionnaire study of 500 cases M. Ujhelyi1, A. Savolt1, D. Pukancsik1, A. Bartal2, I. Kenessey3, Z. Matrai1 1 National Institute of Oncology, Breast and Sarcoma Surgery, Budapest, Hungary