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Prophylactic Buried Dermal Flap with Immediate Lymphatic Reconstruction: Effect on Functional Outcomes after Axillary
Shahnur Ahmed1, Angad Sidhu1, Kasra N Fallah1
1From the Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN (Ahmed, Sidhu, Fallah, Danforth, Bamba, VonDerHaar, Lester, Hassanein).
Background:
Axillary lymph node dissection (ALND) may result in breast cancer-related lymphedema in up to one-third of patients. ALND creates axillary dead space and contributes to decreased range of motion. Immediate lymphatic reconstruction (ILR) is a preventive microsurgical axillary lymphovenous anastomosis to reduce postsurgical lymphedema. This study evaluates the effect of a buried dermal flap as an adjacent local flap on functional limb outcomes in patients after ALND.
Study Design:
A single-center retrospective review was performed for patients who underwent mastectomy, ALND, and ILR (from 2023 to 2024). Patients were divided into 2 groups: group 1 (prophylactic buried dermal flap with ILR) and group 2 (ILR with no flap filling the axillary dead space). Active range of motion (shoulder flexion, shoulder abduction) was the variable of interest.
Results:
The study included 57 patients who underwent mastectomy, ALND, and ILR: group 1 (24 patients) and group 2 (33 patients). Group 1 had greater active range of motion during shoulder abduction (142.4 ± 29.1 degrees) compared with 113.3 ± 31.7 degrees in group 2 (p = 0.0271). Among group 1 patients, shoulder abduction in the postsurgical limb was 142.4 ± 29.1 degrees compared with 160.1 ± 12.1 degrees in the contralateral limb (p = 0.054). In group 2, shoulder abduction was 113.3 ± 31.7 degrees in the postsurgical limb compared with 161.6 degrees in the contralateral limb (p = 0.0006). No patients developed lymphedema. The follow-up time was 249.7 days.
Conclusions:
ALND results in decreased shoulder flexion and abduction. Patients who undergo a prophylactic buried dermal flap have greater preservation of shoulder abduction by 28 degrees compared with those who have ALND without a buried dermal flap.
