Skin grafting utilizing a skin of lateral thoracic area for chest wall reconstruction in patient who underwent mastectom
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CASE REPORT
Skin grafting utilizing a skin of lateral thoracic area for chest wall reconstruction in patient who underwent mastectomy for locally advanced breast cancer Naomi Sakamoto1 · Mika Nashimoto1 · Makiko Nakagawa1 · Yurie Haruyama1 · Yoshitomo Koshida1 · Eisuke Fukuma1 Received: 10 May 2020 / Accepted: 13 October 2020 © The Japanese Breast Cancer Society 2020
Abstract Locally advanced breast cancer sometimes results in a large chest wall defect at mastectomy. When closing the wound horizontally, the skin tension is usually severe in the middle of the wound, while the skin of the lateral area tends to make a dog-ear deformity. Triangle technique is a procedure to prevent the dog ear in which the skin and subcutaneous fat of the axilla are cut into an equilateral triangle. Herein, we present a case of breast cancer who underwent a mastectomy and closed the wound with a skin graft by utilizing the skin removed from lateral thoracic area using triangle technique. An 85-year-old female visited our institution complaining about the mass on her right breast. Preoperative images showed a 10 cm-sized mass with suspicious axillary and mediastinal lymph nodes swelling. A biopsy revealed a hormone receptor-negative, HER2positive invasive ductal carcinoma. A mastectomy and axillary lymph node sampling were performed for a local control as the tumor did not respond to four cycles of triweekly trastuzumab combined with S-1. After a transverse elliptical incision, a skin of the lateral thoracic area was harvested using triangle technique. As the middle of the wound had excessive closing tension, the skin was grafted on the defect. After 10 day fixation by a tie-over dressing, the wound healed without complications. This procedure is a simple method for closing a large defect after mastectomy preventing both the dog-ear deformity and a new wound scarring of a donor site. Keywords Locally advanced breast cancer · Full-thickness skin grafts · Triangle technique · Dog-ear deformity · Chest wall reconstruction
Introduction Locally advanced breast cancer sometimes requires tissue coverage of an extensive chest wall defect at mastectomy. One of the simple ways to close the wound is a bilateral local skin advancement flap in which the skin and subcutaneous fat is undermined superiorly toward the clavicle and inferiorly toward the abdomen [1, 2]. Several procedures have been reported including skin grafts, fasciocutaneous flaps, myocutaneous flaps and perforator flaps when the skin defect is difficult to close by primary or undermining [1–7]. Among these procedures, skin graft is a simple, less invasive * Naomi Sakamoto [email protected] 1
Breast Center, Kameda Medical Center, 929 Higashi‑cho, Kamogawa, Chiba 296‑8602, Japan
and less time-consuming procedure compared to the other procedures; however, an additional scar at the donor site is unavoidable [1, 2, 8]. When closing the wound horizontally after mastectomy, the skin tension is usually severe in the middle of the chest wall, while the skin of the lateral chest wa
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