An extended superficial circumflex iliac artery perforator flap transfer for a relatively-small breast reconstruction after total mastectomy

Reconstruction of Posttraumatic Distal Limb Defects With Free Superficial Circumflex Iliac Artery Perforator Flap

INTRODUCTION

Soft tissue defects in the distal limbs are common after traumatic injury. Repairing such defects is challenging because of the lack of adjacent soft tissue for direct closure or use of a local flap, and functional and aesthetic issues are more prominent in the hands and feet. Thin, unbulky free tissue transfer is ideal for achieving functional and aesthetically pleasing reconstructions. This study reports the use of free superficial circumflex iliac artery perforator (SCIP) flap to reconstruct posttraumatic distal limb defect.

PATIENTS AND METHODS

Thirteen patients with distal limb defects following traumatic injury underwent microsurgical reconstruction with SCIP flap between 2017 and 2022. The defects were located in the upper extremities in 8 patients and lower extremities in 5 patients. Flap thinning was performed to minimize bulkiness, thus restoring functionality and an aesthetically satisfactory appearance.

RESULTS

The patients' average age was 39.8 ± 15.3 years. The average flap size was 13.5 ± 3.4 × 6.7 ± 1.5 cm, and the average pedicle length was 5.2 ± 1.3 cm. Two flaps failed because of unsalvageable venous thrombosis, whereas 2 flaps had salvageable vessel thrombosis. Other flaps survived without major complications. During the average follow-up duration of 7.4± 4.8 months, the functional and aesthetic outcomes were satisfactory after an average of 1 ± 1.2 times of flap revisions.

CONCLUSIONS

With a thin skin paddle, SCIP flap is an available option for posttraumatic distal limb defect reconstruction without much effort of further revisions.

Repair of a "long and narrow" skin defect of the upper extremity with a modified design of a compound SCIP flap: a series of 12 cases

BACKGROUND

Large skin lesions of the upper extremity tend to be ''long and narrow'' in shape, and the currently used repair and reconstruction protocols still have some drawbacks, including difficulty in closure of the donor area, poor cosmetic appearance of the donor and recipient areas, and low flap survival rates. The ilioinguinal flap has been more widely used for repair and reconstruction of various complex conditions. In order to improve the versatility of the flap design and to achieve better aesthetic results, we report a study on the improved design of Compound SCIP flap for repairing "long and narrow" large skin defects of the upper extremity by using a modified design of the ilioinguinal flap for the procurement of perforating blood vessels and flap excision.

METHODS

From April 2005 to August 2015, a total of 12 patients underwent this modified design procedure, in which the anterior branch of the fourth lumbar artery or the posterior intercostal artery was selected to provide blood supply for the perforator flap together with the superficial branch of the superficial iliac artery to meet the blood supply needs of the flap for the one-time repair of a large "long and narrow" skin defect in the upper limb. Patient demographics, flap characteristics, and associated complications were retrospectively analyzed.

RESULTS

3 females and 9 males were included in this study, the mean age of the patients was 31.7 years (range, 22-44 years), the mean follow-up period was 15.3 ± 5.6 months (range, 7-24 months), and all patients had complete closure of the defect site and donor area, and all flaps survived.

CONCLUSIONS

The Compound SCIP flap presents some advantages in repairing 'long and narrow' skin defects in the upper limb. While ensuring the survival rate of the elongated ilioinguinal flap, it amplifies the benefits of the ilioinguinal flap and enhances skin utilization. This can serve as a beneficial choice for repairing 'long and narrow' skin defects in the upper limb.

Immediate Partial Breast and Nipple-Areola Complex Reconstruction Using a Superficial Circumflex Iliac Artery Perforator Flap

The superficial circumflex iliac artery perforator (SCIP) flap is a versatile flap that has been described for various applications, mostly for lower extremity coverage and head and neck reconstructions. However, there are few publications reporting its use for breast reconstruction, mainly because of its low volume availability. In this article, we present the case of a patient who successfully underwent a partial breast and immediate nipple-areola complex (NAC) reconstruction with an SCIP flap. She had been previously reconstructed with an implant after a nipple-sparing mastectomy, but the NAC turned out to be involved with cancer needing further resection. Our goal with this article, is to introduce a novel concept for addressing partial breast and NAC reconstruction and mostly, to illustrate the importance of an adaptable surgical plan based on every individual case emphasizing the versality of microsurgery for breast cancer reconstruction.

Engineering liquid metal-based nanozyme for enhancing microwave dynamic therapy in breast cancer PDX model

BACKGROUNDS

The novel concept of microwave dynamic therapy (MDT) solves the problem of incomplete tumor eradication caused by non-selective heating and uneven temperature distribution of microwave thermal therapy (MWTT) in clinic, but the poor delivery of microwave sensitizer and the obstacle of tumor hypoxic microenvironment limit the effectiveness of MDT.

RESULTS

Herein, we engineer a liquid metal-based nanozyme LM@ZIF@HA (LZH) with eutectic Gallium Indium (EGaIn) as the core, which is coated with CoNi-bimetallic zeolite imidazole framework (ZIF) and hyaluronic acid (HA). The flexibility of the liquid metal and the targeting of HA enable the nanozyme to be effectively endocytosed by tumor cells, solving the problem of poor delivery of microwave sensitizers. Due to the catalase-like activity, the nanozyme catalyze excess H2O2 in the tumor microenvironment to generate O2, alleviating the restriction of the tumor hypoxic microenvironment and promoting the production of ROS under microwave irradiation. In vitro cell experiments, the nanozyme has remarkable targeting effect, oxygen production capacity, and microwave dynamic effect, which effectively solves the defects of MDT. In the constructed patient-derived xenograft (PDX) model, the nanozyme achieves excellent MDT effect, despite the heterogeneity and complexity of the tumor model that is similar to the histological and pathological features of the patient. The tumor volume in the LZH + MW group is only about 1/20 of that in the control group, and the tumor inhibition rate is as high as 95%.

CONCLUSION

The synthesized nanozyme effectively solves the defects of MDT, improves the targeted delivery of microwave sensitizers while regulating the hypoxic microenvironment of tumors, and achieves excellent MDT effect in the constructed PDX model, providing a new strategy for clinical cancer treatment.