Prophylactic Buried Dermal Flap with Immediate Lymphatic Reconstruction: Effect on Functional Outcomes after Axillary...

Area of Science:

• Microsurgery
• Surgical Oncology
• Lymphedema Research

Background:

• Axillary lymph node dissection (ALND) for breast cancer can lead to lymphedema in up to 33% of patients.
• ALND can cause axillary deadspace and reduce shoulder range of motion.
• Immediate lymphatic reconstruction (ILR) via axillary lymphovenous anastomosis is a preventative microsurgical technique.

Purpose of the Study:

• To evaluate the impact of a prophylactic buried dermal flap on functional limb outcomes post-ALND.
• To compare shoulder range of motion in patients undergoing ILR with and without a buried dermal flap.
• To assess the efficacy of buried dermal flaps in preventing lymphedema after ALND.

Main Methods:

• Retrospective review of 57 patients undergoing mastectomy, ALND, and ILR (2023-2024).
• Patients were divided into two groups: Group 1 (ILR with buried dermal flap) and Group 2 (ILR without flap).
• Active range of motion (AROM) for shoulder flexion and abduction was the primary outcome measure.

Main Results:

• Group 1 (n=24) demonstrated significantly greater shoulder abduction AROM (142.4±29.1°) compared to Group 2 (n=33) (113.3±31.7°, p=0.0271).
• In Group 1, postsurgical shoulder abduction was comparable to the contralateral limb (p=0.054).
• Group 2 showed a significant deficit in postsurgical shoulder abduction compared to the contralateral limb (p=0.0006). No lymphedema was reported in either group.

Conclusions:

• ALND negatively impacts shoulder flexion and abduction.
• A prophylactic buried dermal flap significantly enhances shoulder abduction preservation by approximately 28 degrees post-ALND compared to ILR alone.
• Buried dermal flaps appear effective in improving functional outcomes and preventing lymphedema after ALND.