OBJECTIVES:SSc is an autoimmune connective tissue disease involving multiple organs. The most common clinical symptom of SSc is progressive fibrosis of the skin, and the pathologically manifestations of skin were activation and proliferation of fibroblasts and continuous proliferation of extracellular matrix. TGF-β can promote the proliferation and activation of fibroblasts, causing excessive deposition of collagen and structural proteins. Therefore, exploring the specific mechanism of TGF-β-related pathway on fibrosis is of great significance for improving skin fibrosis in SSc. METHODS:Genes related to TGF-β pathway were screened through bioinformatics analysis, and SSc phenotypes were verified in vivo and in vitro. The relevant molecular mechanisms were preliminarily discussed in combination with transcriptome sequencing. RESULTS:Human cysteine-rich secreted protein LCCL domain protein 2 (CRISPLD2) was found increased reactivity in TGF-β-induced fibroblasts, and the expression of ACTA2 (ɑ-SMA) decreased significantly in TGF-β-mediated fibroblasts with up-regulation of CRISPLD2. CONCLUSION:CRISPLD2 was found to have increased reactivity in TGF-β-induced fibroblasts, and we further confirmed that CRISPLD2 can participate in TGF-β-induced fibroblast fibrosis from multiple perspectives and levels in negative feedback regulation, and investigated the mechanism of CRISPLD2 in fibrosis.

AIM:To investigate the effect of abatacept in the hypochlorous acid (HCLO)-induced fibrosis model and to analyze changes in immune cell fractions within the abatacept-treated early diffuse systemic sclerosis (SSc) cohort. METHODS:Fibrosis was induced in BALB/c mice by subcutaneous injection of HCLO, and abatacept was injected intraperitoneally on alternate days starting on day 28. After 6 weeks, we assessed the pathological changes, inflammation, myofibroblast activation, and the percentage of ICOS in CD3+ T cells. Potential pathways affected by abatacept were also investigated. Finally, we analyzed immune infiltration and multiple scores in early diffuse SSc patients and in the skin and lung tissues of the HCLO model after abatacept administration. RESULTS:Abatacept significantly decreased the proportion of M2 macrophages in the abatacept-treated HCLO model and the inflammatory improver subset of SSc patients. Furthermore, abatacept reduced CD28 signaling, the inflammation-related pathway, and the ICOS expression on CD3+ T cells in HCLO mice. In the inflammatory subset of SSc patients and HCLO mice, microenvironmental and immune scores tended to decrease after abatacept treatment. Unexpectedly, abatacept had no effect on skin or lung collagen content in HCLO mice. The number of T cells and myofibroblasts was not reduced in the abatacept-treated HCLO group. CONCLUSION:Although abatacept did not improve skin and lung fibrosis in the HCLO mice, it reduced the immune response signature and the proportion of M2 macrophages. These findings suggest that further research is needed to assess the therapeutic value of abatacept in SSc patients and preclinical mouse models.

Breast cancer is the most common and lethal malignancy among women worldwide. Cuproptosis, a newly identified copper-dependent cell death, is closely associated with cancer development. However, its regulatory mechanisms in breast cancer are not well studied. This study aims to establish a prognostic model for breast cancer to improve risk stratification. The mRNA expression data was downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases. Consensus clustering identified patterns based on cuproptosis-related genes. Key genes were screened using Weighted Gene Co-Expression Network Analysis and differentially expressed gene analysis. A prognostic model was constructed using Cox regression and evaluated with time-dependent receiver operating characteristic and Kaplan-Meier analyses. Functional pathways, immune cell infiltration, and other tumor characteristics were also analyzed. Two distinct cuproptosis patterns were identified. The top 21 differentially expressed genes, significantly associated with survival, were used to construct the prognostic model. The risk score has a negative correlation with survival. Enrichment analysis showed immune-related pathways enriched in the low-risk group, which also had more immune cell infiltration, higher stromal component, lower tumor purity, and lower tumor heterogeneity. Finally, significant differences of half maximal inhibitory concentration were also observed between patients in high- and low-risk groups who received chemotherapy and targeted therapy drugs. These findings in our study may provide evidence for further research and individualized management of breast cancer.

Background Alternative splicing (AS) and intron retention (IR) implicated in multiple pathophysiological processes, have rarely been reported in systemic sclerosis (SSc). Methods We integrated bulk RNA-seq and 4D label-free mass spectrometry to perform a multi-omics analysis of AS and IR in SSc skin tissue and fibroblasts. RMATS and iREAD were used to identify AS and IR, which were validated by real-time PCR. Spearman correlation and the LASSO method were employed to assess correlations among clinical features, introns, splicing factors (regulators of AS) and proteins. Findings AS profiles showed distinct alterations in SSc skin tissue, with the most pronounced changes occurring in IR. AS and IR were associated with total modified Rodnan skin score (mRSS) and local skin score. Upon TGF-β stimulation, fibroblasts exhibited significant alterations in IR profiles, affecting genes related to fibroblast proliferation and collagen fibril organization. A comprehensive integrated analysis of introns, exons, and proteome profiles revealed that IR exerted a negative impact on protein expression, with certain changes being under intronic control. RT-PCR confirmed the presence of intron and exon-derived sequences of CTTN, OGA, MED16 and PHYKPL. Additionally, notable changes were observed in the regulatory network of splicing factors in SSc skin tissues. These factors are also involved in fibrosis pathways and correlated with clinical features. Conclusion Totally, abnormal AS, IR profiles and splicing factors were identified in SSc, altered IRs and splicing factors participated in fibrosis-related pathways. IR exerted a negative impact on protein expression in TGF-β-stimulated fibroblasts. Clarification of the IR mechanisms will provide new insights into the pathophysiology of SSc.

Abstract Background ADAM19 (ADAM Metallopeptidase Domain 19) is known to be involved in extracellular matrix (ECM) remodeling, yet its specific function in systemic sclerosis (SSc) fibrosis remains unclear. Objectives This study sought to clarify the role and underlying mechanism of ADAM19 in SSc skin fibrosis. Methods The expression of ADAM19 was assessed in skin tissues of SSc and wound healing using publicly available transcriptome datasets. This analysis was further validated through real-time PCR, western blot, and immunostaining in our SSc cohort, as well as in a mouse model of hypochlorite (HOCl)-induced fibrosis. To downregulate the expression of ADAM19, ADAM19 siRNA was employed. The influence of ADAM19 on fibroblast transcriptomics was examined using bulk RNA-seq. Data analysis and visualization were conducted using R packages, including edgeR, limma, clusterProfiler, ggplot2, gseaplot2, and complexheatmap. Results ADAM19 exhibited a significant upregulation in skin tissues of SSc patients, as well as in wound healing and a HOCl-induced fibrosis mouse model. Additionally, there was a notable positive correlation between ADAM19 and fibrosis-related genes, local skin score, Modified Rodnan skin score, skin thickness progression rate, and the presence of ARA antibodies in SSc patients. Furthermore, ADAM19 levels were markedly elevated in SSc primary dermal fibroblasts and TGF-β-stimulated healthy controls primary dermal fibroblasts. The downregulation of ADAM19 resulted in the repression of TGF-β-induced ECM deposition and fibroblast activation. ADAM19 was identified as a mediator for the shedding of neuregulin-1 (NRG1) in fibroblasts, a pro-fibrotic cytokine that must be cleaved to exert its function. Conclusion ADAM19 plays a role in TGF-β-induced ECM deposition and fibroblast activation by mediating the shedding of NRG1, ultimately contributing to the development of skin fibrosis in SSc.

On June 15, 2021, a female patient with right breast cancer aged 43 years old was admitted in Hunan Cancer Hospital. She received left mastectomy 13 years ago and left breast reconstruction with pedicled rectus abdominis myuocutaneous flap 6 years ago. After admission, she received right mastectomy and immediate right breast reconstruction with bilateral free medial arm perforator flaps. The lateral side of the breast was reconstructed with the ipsilateral medial arm flap. The superior ulnar collateral vessels were anastomosed with the proximal end of the lateral thoracic artery and distal end of the lateral thoracic vein. And the contralateral medial arm flap was used to reconstruct the medial part of the breast. The superior ulnar collateral vessels were anastomosed with the proximal and distal ends of the internal mammary vessels. After revascularization, the blood supply of the flap was good, and the donor sites were closed directly. The postoperative course of the patient was stable, the flap survived well, and the donor area healed well. In the two-month follow-up, the appearance and function of the flap donor area was good, there were no obvious complications, while the reconstructed breast shape was not satisfactory. This case suggests that the combined transplantation of bilateral free arm medial perforator flaps is suitable for small and medium-sized breast reconstruction, but not enough for large-volume breast reconstruction.

In December 2021, a 37-year-old female patient was admitted to the Department of Oncology Plastic Surgery, Hunan Cancer Hospital, 32 months after bilateral mastectomy. After admission, it was planned to perform bilateral breast reconstruction with bilateral free deep inferior epigastric artery perforator (DIEP) flap and bilateral free posterior medial thigh perforator flap. The ipsilateral lower abdominal flap and posterior medial thigh flap were stacked to reconstruct the ipsilateral breast, and the vascular pedicle of profunda artery perforator was anastomosed with the distal end of internal mammary vessel, the deep inferior epigastric artery was anastomosed with the proximal end of the internal mammary vessel. During the operation, the blood supply of the flap was good, and the donor sites of the thigh and abdomen were closed directly. The postoperative course of the patient was stable, the flap survived well, and the donor site healed well. After 1 month follow-up, the appearance and function of the donor area of abdomen and thigh were good, no obvious complications were found, and the reconstructed breast shape was satisfactory. This case suggests that the combined transplantation of free DIEP flap and posterior medial thigh perforator flap is suitable for the reconstruction of large breast.

Objective:To explore the application of the classification of the accompanying vein of deep inferior epigastric artery and vascular anastomotic strategy in breast reconstruction.Methods:The data of patients who underwent breast reconstruction after breast cancer surgery with unilateral free lower abdominal flap transplantation in Hunan Cancer Hospital from October 2015 to January 2021 were retrospectively analyzed. During surgery, free deep inferior epigastric artery perforator (DIEP) flap or free muscle-sparing rectus abdominis musculocutaneous flap was used for breast reconstruction, and the recipient vessel was internal mammary vessel. The anatomy of the accompanying vein of the deep inferior epigastric artery can be divided into three types: independent type, including one branch type and two branch type; Y-shaped structure; H-shaped structure. Direct anastomosis was used for independent veins. There were five methods of vascular anastomoses for Y-shaped and H-shaped accompanying vein: (1) direct anastomosis; (2) the Y-shaped common stem segment was removed and the two accompanying veins were anastomosed respectively; (3) ligate the communicating branch and anastomose the two accompanying veins respectively; (4) the communicating branch was reserved and the two accompanying veins were anastomosed respectively; (5) ligate the smaller accompanying vein and anastomose the larger accompanying vein. Methods 1 and 2 were suitable for Y-shaped accompanying veins, and methods 3 to 5 were suitable for H-shaped accompanying veins. The excessively long inferior abdominal artery segment was removed during the operation. The complications of intraoperative vascular anastomosis were counted, and the survival of flap, aesthetics of breast reconstruction and tumor recurrence were followed up.Results:A total of 173 female patients were included, ranging from 26 to 60 years, with an average age of 41.2 years. There were 92 cases of immediate breast reconstruction and 81 cases of delayed breast reconstruction. 109 cases of free DIEP flap and 64 cases of free muscle-sparing rectus abdominis musculocutaneous flap were harvested. The length of the flap was (26.9±1.9) cm, the width of the flap was (11.3±0.7) cm, the length of the vascular pedicle was (10.5±0.4) cm. The anatomical type of the deep inferior epigastric artery with only one accompanying vein accounted for 16 cases, and the veins were anastomosed directly. The anatomical type of Y-shaped accompanying vein accounted for 14 cases, of which 5 cases were anastomosed directly using method 1, 3 cases were anastomosed directly using method 1 after partial resection of the third costal cartilage to create a groove, and 6 cases were anastomosed using method 2. The H-shaped accompanying vein of the deep inferior epigastric artery was found in 143 cases. In 96 cases, vascular anastomosis were accomplished using method 3, 19 cases were anastomosed using method 4 and 28 cases were anastomosed using method 5. In 97 cases, the excessively long segment of the deep inferior epigastric artery were trimmed before vascular anastomosis. The average length of the trimmed segment was (2.7±0.7) mm. There were 6 cases of vascular anastomotic complications during operation, of which 2 patients were treated with method 1. Venous entrapment occurred during operation and was relieved after changing into method 2. The venous anastomosis methods adopted in the other 4 cases included 1 case of method 2, 1 case of method 3, and 2 cases of method 4, all of which were relieved of vessel entrapment by timely adjusting the placement of vessel pedicles. Postoperative flap necrosis occurred in 1 case. The vein anastomosis was direct Y-shaped vein anastomosis. The remaining 172 cases were completely successful. The patients were followed up for 10 to 36 months, with an average of 18.7 months. The reconstructed breast shape was good, the texture was soft, without flap contracture and deformation. Only linear scar remained in the donor site of the flap, which had no significant effect on the function of the abdominal wall. No tumor recurrence was observed.Conclusion:By flexibly adjusting the vascular anastomosis strategy according to the classification of the accompanying vein of the deep inferior epigastric artery, the blood supply of the free lower abdominal flap transfer in breast reconstruction can be guaranteed to the greatest extent.

Crocin has been reported to have antitumor activity in several tumors including breast cancer. Nevertheless, the mechanism of action of crocin on breast cancer remains unclear. The cytotoxicity of crocin was evaluated by CCK-8 assay. Cell proliferation was assessed using EdU incorporation assay and western blot analysis. Breast cancer-related genes were extracted from GEPIA. miR-122-5p targets were predicted using Targetscan, starbase, and miRDB softwares. Luciferase reporter assay was employed to confirm whether miR-122-5p targeted sprouty2 (SPRY2) and forkhead box P2 (FOXP2). Results showed that crocin exhibited cytotoxicity and suppressed the proliferation in breast cancer cells. miR-122-5p was upregulated in breast cancer tissues and cells. Crocin suppressed miR-122-5p to block the proliferation of breast cancer cells. Seven targets of miR-122-5p were identified in breast cancer. SPRY2 and FOXP2 were selected for further experiments due to their involvement in breast cancer. miR-122-5p targeted SPRY2 and FOXP2 to inhibit their expression. miR-122-5p knockdown restrained breast cancer cell proliferation by targeting SPRY2 and FOXP2. Additionally, crocin increased SPRY2 and FOXP2 expression by inhibiting miR-122-5p expression. Together, our results suggested that crocin inhibited proliferation of breast cancer cells through decreasing miR-122-5p expression and the subsequent increase of SPRY2 and FOXP2 expression.

目的 探讨扩大股前外侧肌皮瓣移植修复超大面积胸壁缺损的临床疗效。方法 2018年8月—2020年12月，采用扩大股前外侧肌皮瓣移植修复胸壁肿瘤术后超大面积复杂胸壁缺损患者12例。其中男4例，女8例；年龄28～72岁，平均54.9岁。叶状细胞肉瘤4例，软组织肉瘤2例，肺癌转移胸壁肿瘤1例，乳腺癌复发5例。患者曾行2～7次肿瘤切除手术；其中3例既往行下腹部皮瓣移植手术失败，余9例患者因消瘦不适合采用腹部作为皮瓣供区。创面彻底清创后继发胸壁缺损面积为300～600 cm2；切取皮瓣长（24.7±0.7）cm，皮岛宽（10.6±0.7）cm，股外侧肌瓣长（26.8±0.5）cm，宽（15.3±0.6）cm，血管蒂长度为（7.9±0.6）cm。结果 11例患者肌皮瓣完全成活，肌瓣表面植皮全部成活，供受区创面均Ⅰ期愈合；1例男性患者胸壁切口裂开，进一步采用大网膜联合皮片移植修复。12例患者重建胸壁外形可，质地满意，无皮瓣挛缩变形；皮瓣供区仅遗留线性瘢痕，取皮区轻度增生瘢痕，大腿功能无明显影响。所有患者均获随访，随访时间9～15个月，平均12.6个月。未见肿瘤复发患者。结论 扩大股前外侧肌皮瓣手术操作简便，有效修复面积明显增加，避免了多皮瓣移植，可作为超大面积胸壁缺损修复的挽救手段。

Long noncoding RNAs (lncRNAs) have been reported to play a key role in regulating tumor microenvironment and immunity. Cancer-associated fibroblasts (CAFs) are abundant in many tumors. However, the functional and clinical significance of lncRNAs specifically expressed in CAFs has not been fully elucidated. In this study, we identified a list of 95 CAF-specific lncRNAs (FibLnc), including HHLA3, TP53TG1, ST7-AS1, LINC00536, ZNF503-AS1, MIR22HG, and MAPT-AS1, based on immune cell transcriptome expression profiling data. Based on the Cancer Genome Atlas and Gene Expression Omnibus datasets, we found that the FibLnc score predicted differences in overall patient survival and performed well in multiple datasets. FibLnc score was associated with the clinical stage of patients with breast cancer but did not significantly correlate with the PAM50 classification. Functional analysis showed that FibLnc was positively correlated with signaling pathways associated with malignant tumor progression. In addition, FibLnc was positively correlated with tumor mutational load and could predict immunotherapy response in patients with breast cancer receiving anti-PD-1 or anti-CTLA4 therapy. Our proposed FibLnc score was able to reflect the status of the immune environment and immunotherapeutic response in breast cancer, which could help explore potential therapeutic decisions and regulatory mechanisms of CAF-specific lncRNAs.

Karanjin is a bioactive furanoflavonoid with various pharmacological activities including anticancer activities. However, the effect and the related mechanism of karanjin in breast cancer (BC) have not been revealed. The potential targets of karanjin and BC were predicted using SwissTargetPrediction and GeneCards databases, respectively. The overlapping targets between karanjin and BC were identified using the Venn diagram. DAVID database was used for the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathway analysis. Cell viability, proliferation, and apoptosis were examined by MTT (3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-tetrazolium bromide), EdU (5-ethynyl-2'-deoxyuridine) incorporation, and TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP digoxigenin nick-end labeling) assays, respectively. The protein levels were measured by western blot analysis. We screened out 28 overlapping targets between karanjin and BC. KEGG analysis showed that the targets of karanjin in BC were associated with the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway. Karanjin inhibited cell viability and impeded the proliferative ability of BC cells. Moreover, karanjin treatment induced apoptosis in BC cells. Additionally, karanjin treatment blocked the PI3K/Akt signaling pathway and activation of the PI3K/Akt pathway reversed the antitumor effect of karanjin on BC cells. In conclusion, karanjin exerted antitumor activity in BC cells by regulating the PI3K/Akt signaling pathway.

Background and purposeResection of radiation-induced ulcers often causes full-thickness defects of the chest wall. We retrospectively reviewed and evaluated 17 patients to explore a method of chest wall reconstruction. Materials and methodsA total of 17 breast cancer patients with radiation-induced ulcers were included. Various type of prostheses and flaps were used, results of clinic were evaluated. ResultsSixteen patients had full-thickness defects and one patient had only a soft tissue defect and underwent reconstruction with a pedicle latissimus dorsi (LD) myocutaneous flap. Among all 16 full-thickness defect cases, 15 patients underwent bony thoracic reconstruction using polymesh/3D-printed titanium plates or methyl methacrylate. For soft tissue reconstruction, 13 patients reconstruction using a free deep inferior epigastric perforator (DIEP) flap in combination with a contralateral transverse rectus abdominis myocutaneous (TRAM) flap, and 2 underwent pure free DIEP flap reconstruction. Among all the patients 15 healed with no complications, and 2 patients had delayed healing on the edges of the flaps. ConclusionsDistant pedicle or free flap can used for soft tissue defect coverage, for those severe patients with full-thickness defects and used prostheses, free deep inferior epigastric perforator flap in combination with a contralateral transverse rectus abdominis myocutaneous flap (TRAM + DIEP) would be an applicable choice.

ATP-binding cassette (ABC) subfamily A member 8 (ABCA8) has been reported to play a vital role in cancer development. Our study aimed to explore the role and the molecular mechanism of ABCA8 in breast cancer (BC) progression. GSE65194, GSE15852, and GSE45827 datasets were used to identify differentially expressed genes (DEGs) in BC. The diagnosis and prognosis value were determined using ROC curve analysis and Kaplan-Meier plotter, respectively. The relationship between ABCA8 expression and clinicopathological features in BC was analyzed by TCGA. Co-expressed genes of ABCA8 in BC were screened out through GEPIA and subjected to KEGG pathway enrichment analysis. Cell proliferation was evaluated by CCK-8 and EdU incorporation assays. Proliferating cell nuclear antigen (PCNA) expression and the changes of the AMP activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway were measured by western blot analysis. Totally 4 overlapping DEGs were identified and all reduced in BC samples. ABCA8 with high diagnostic and prognostic values was selected for further exploration. Low ABCA8 expression was correlated with clinicopathological features in BC patients. ABCA8 overexpression inhibited BC cell proliferation. The top 20 co-expressed genes of ABCA8 were identified by GEPIA and significantly enriched in AMPK signaling pathway. Inhibition of AMPK/mTOR pathway reversed the suppressive effect of ABCA8 on BC cell growth. These results suggested that ABCA8 overexpression repressed BC cell proliferation through regulating the AMPK/mTOR signaling pathway.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

目的 总结双侧下腹部皮瓣游离移植再造1例Poland综合征乳腺癌患者双侧乳房的经验.方法 2020年7月,收治1例41岁Poland综合征双侧乳腺导管内癌女性患者.入院后行双乳皮下腺体切除+双侧下腹部皮瓣游离移植(右侧保留部分腹直肌的腹直肌皮瓣、左侧腹壁下动脉穿支皮瓣)+双侧乳房再造术.腹部皮瓣供区直接拉拢闭合.结果 手术时间11h.术后皮瓣成活良好,供区切口Ⅰ期愈合.患者获随访3个月,腹部供区皮缘少许痂皮未脱落,创面已愈合,未见明显并发症.左侧重建乳房较右侧小,患者对重建乳房功能、外形均满意.结论 对于Poland综合征双侧乳腺癌患者,采用双侧下腹部皮瓣游离移植可一期再造双侧乳房.

OBJECTIVE:To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar. METHODS:The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases. RESULTS:All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found. CONCLUSION:It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.

OBJECTIVE:To explore the surgical technique, effectiveness, and safety of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction.METHODS:Between December 2016 and February 2019, 6 cases of early breast cancer received modified radical surgery, lower abdominal flap was applied for one- or two-staged breast reconstruction. The average age of the patients was 34.6 years (range, 29-56 years). The disease duration ranged from 2 to 16 months, with an average of 9.5 months. The tumor was located in the upper outer quadrant in 4 cases and the lower outer quadrant in 2 cases. Pathological examination showed that they were all invasive ductal carcinoma. Four cases of breast cancer were in stage Ⅰ and 2 cases was in stage Ⅱ. During operation, the inferior epigastric artery perforators were found to be close to the upper edge of the flap and/or near the umbilical cord in 4 cases, the inferior epigastric artery perforator vessels were relatively small (<0.3 mm) in 2 cases; and the breast was reconstructed with muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator. The length, width, and thickness of the flap were (28.9±0.2), (12.1±0.4), and (4.4±0.3) cm, respectively. The length of the vascular pedicle was (11.5±0.2) cm and the weight of the flap was (420.5±32.7) g.RESULTS:All 6 muscle-sparing rectus abdominis myocutaneous flaps were successful, and the breast incisions healed by first intention. There was no vascular crisis, donor site effusion, hematoma, or infection. All 6 patients were followed up 12-36 months (mean, 26.8 months). The reconstructed breast had a good shape, good elasticity, and no flap contracture or deformation; only linear scars left at the donor site of the flap, and the abdominal wall function was not affected. During follow-up, there was no breast cancer recurrence and metastasis.CONCLUSION:When the inferior epigastric artery perforators are too close to the upper edge of the flap and/or near the umbilical cord, the vascularity of lower abdominal flap can be ruined, harvested in form of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator can efficiently ensure blood supply safety.

Objective:This study aimed to explore the clinical application methods and outcomes of innervated deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction.Methods:A retrospective analysis was conducted on 12 female patients with unilateral early breast cancer (clinical stage Ⅰ/Ⅱ) who were admitted from October 2015 to February 2017 in Hunan Cancer Hospital and received modified radical surgery and breast reconstruction by using the DIEP flap with sensory nerve repair (the sensory branch of intercostal nerve in the flap was coated with the third intercostal nerve). The patients' age ranged from 33 years to 52 years (mean age, 37.4±3.5 years). In all flap transplantations, the deep inferior epigastric vessels were anastomosed with internal mammary vessels or thoracodorsal vessels in the recipient sites. Each breast was subdivided into four quadrants. One central region with pressure, hot, and cold recognition was tested in every area. Each patient received a questionnaire asking for their subjective opinion about their breast shape outcome, return of sensation, erogenous sensation, and overall satisfaction.Results:The flap had a length of (32.3±0.4)cm, width of (12.7±1.6)cm, and thickness of (3.8±0.4) cm. The length of pedicle was (12.5±0.4) cm, the outer diameter of artery pedicle was (1.7±0.4)mm, and the outer diameter of venae comitant was (2.2±0.7)mm. The length of sensory branch of intercostal nerve was (2.3±0.4)cm. The recipient vessels included internal mammary vessels (seven cases) and thoracodorsal vessel (five cases). All the recipient nerves are the third intercostal nerve. All flaps were successfully implanted. In one flap donor site, fat necrosis occurred and healed with dressing treatment. No other complications were noted. The reconstructed breasts' shape, texture, and elasticity were good, and no flap contracture deformation was noted. Only linear scar was left in the donor sites, and the abdominal function was not affected. All 12 patients were followed up for 12-38 months (averaged 19.6 months) with satisfying results. No local recurrence happened. At 12 months after breast reconstruction, the neurotization of the DIEP flap resulted in the recovery of sensibility. In all 12 cases (100%) of the DIEP flaps with sensory nerve repair, at least protective sensation was present in all five segments of the breast. Responses to cold or warm stimuli were still present.Conclusions:DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to increase the sensory recovery for patients undergoing breast reconstruction.