Download PDF
CC BY-NC-ND 4.0 · Asian Journal of Oncology 2022; 08(03): 140-146
DOI: 10.1055/s-0042-1748861
Case Report

Horse-Shoe Flap Reconstruction Technique in Breast Surgery: From The Smallest Defect to The Biggest—A Case Series

Ida Bagus Made Suryawisesa 
1   Division of Oncology Surgery, General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
,
I. Nyoman Wawan Tirtha Yasa
1   Division of Oncology Surgery, General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
,
Ida Bagus Tjakra Manuaba
1   Division of Oncology Surgery, General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
,
Kelvin Setiawan
2   General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Chest wall resections and reconstructions are routinely performed to close defects after primary breast tumor resections. Depending on the size of primary breast tumors, the reconstructive technique requires more challenging approaches. In this study, we would like to introduce a novel technique which can be applied as a method in covering various sizes of skin defects after mastectomy termed as “horse-shoe flap technique.” We conducted a series of case reports of patients who underwent chest wall coverage after primary breast tumor resections between October 2018 and November 2019 and selected five cases of breast cancer patients. These patients were treated with the horse-shoe flap technique which relies on shape as its main concept. All chest defects must form a circular shape, based on the principle that adequate safe tumor margins are best achieved with a circular incision. The donor flap was drawn and taken from the outer circle area with a larger arc, depending on the defect's diameter size. Five post-mastectomy chest wall defect cases had been successfully closed with this technique. Patients were all female, ranging from 36 to 55 years of age. The smallest chest defect was 4 cm in diameter, and the largest was 26 cm. All the defects were closed using a 120-degree horse-shoe flap design. One patient experienced marginal necrotic skin, and one case had formed postoperative seroma. The horse-shoe flap technique proves to be an excellent option for closing chest skin defects which can be applied for various sizes of skin defects with minor complications.

Keywords

horse-shoe flap - breast cancer - breast reconstruction


Publication History

Article published online:
27 June 2022

© 2022. Spring Hope Cancer Foundation & Young Oncologist Group of Asia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mansour KA, Thourani VH, Losken A. et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73 (06) 1720-1725 , discussion 1725–1726
    CrossrefPubMedGoogle Scholar
  • 2 Billington A, Dayicioglu D, Smith P, Kiluk J. Review of procedures for reconstruction of soft tissue chest wall defects following advanced breast malignancies. Cancer Contr 2019; 26 (01) 1073274819827284
    Google Scholar
  • 3 Merritt RE. Chest wall reconstruction without prosthetic material. Thorac Surg Clin 2017; 27 (02) 165-169
    CrossrefPubMedGoogle Scholar
  • 4 Hamdi M, Craggs B, Stoel AM, Hendrickx B, Zeltzer A. Superior epigastric artery perforator flap: anatomy, clinical applications, and review of literature. J Reconstr Microsurg 2014; 30 (07) 475-482
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Alvarado A. Reciprocal incisions for closure of circular skin defects. Plast Reconstr Surg 1981; 67 (04) 482-491
    CrossrefPubMedGoogle Scholar
  • 6 Mehrara BJ, Ho AY. Breast reconstruction. In: Harris JR, Lippman ME, Morrow M, Osborne CK. eds. Diseases of the breast. 5th ed. Philadelphia, PA: Wolters Kluwer Health; 2014: 536-549
    Google Scholar
  • 7 Bailey CM, Pu LQ. Breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap. In: Pu LQ. Karp NS. eds. Atlas of Reconstructive Breast Surgery. Edinburgh, Scitland: Elsevier; 2020: 1-15
    Google Scholar
  • 8 Vasconez LO, Cerio DR. Autologous reconstruction TRAM flap. In: Bland KI. Klimberg VS. eds. Master Techniques in General Surgery: Breast Surgery. Philadelphia, PA: Wolters Kluwer Health; 2011: 439-441
    Google Scholar
  • 9 Wu S, Mo M, Wang Y. et al. Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management. OncoTargets Ther 2016; 9: 6829-6834
    CrossrefPubMedGoogle Scholar
  • 10 Mirzabeigi MN, Rhemtulla IA, Mcdonald ES. et al. Locoregional cancer recurrence after breast reconstruction: detection, management and secondary reconstructive strategies. Plast Reconstr Surg 2019; 143 (05) 1322-1330
    CrossrefPubMedGoogle Scholar
  • 11 Wysong A, Higgins S. Basic principles in flap reconstruction. In: Flaps and Grafts in Dermatologic Surgery. 2nd ed. Edinburgh, Scotland: Elsevier; 2019: 16-17
    Google Scholar
  • 12 Einstein A. Design principles and the keystone technique. In: The Keystone Perforator Island Flap Concept. Sydney, Australia: Elsevier; 2012. -28
    Google Scholar