Surgical complications of breast cancer treatment. (A) bleeding
1. Intraoperative blood vessels and the respective branch of the axillary dissection, cut off the breast muscle attachment points, especially when the line Patey's modified radical, is easy to support breast thoracoacromial artery damage, leading to bleeding, so patients should pay attention to the anatomy of some of the above identification, Handle with care.
2. Modern breast surgery operations, mostly electric knife sharp separation, in the free flap and the removal of the breast gland, the subcutaneous blood vessels and mammary blood supply for the electrical branch multi-coagulation, after flushing and early postoperative upper limb activities condensate volume can fall off, resulting in bleeding. It should be sufficient to stop bleeding flap closure, two days after upper limb should be braking to avoid and outreach on the move. Removal of internal mammary or axillary drainage tube and make the coffee pour off that may cause bleeding, it should be lifted after the removal of negative pressure drainage tube, with special attention to the second intercostal space through the processing vessel.
(B) of the pneumothorax
Mostly cut off the beginning part of pectoral muscle injury caused when, line, especially when surgical Patey's attention, if necessary, can be used for closed thoracic drainage.
(C) of the skin flap necrosis
Electric knife to cut open the skin, cut edge of the common linear, skin flap necrosis, generally no special treatment, suture removal can be delayed. Large areas of skin flap necrosis, mostly for free flap, the subcutaneous capillary network due to inadequate protection. Incision well designed, suture tension is too large can cause skin flap necrosis, common in the cut edge. Therefore, when the flap is not too thin, pay attention to skin and superficial fascia in separation, capillary network and the thin layer of fat reserves. Design incision, to avoid too much tension suture, skin grafting may be considered necessary.
(D) subcutaneous fluid
Inadequate intraoperative bleeding, intraoperative and clear separation of axillary lymphatic glands when the treatment ends due to imprecise. Intraoperative ligation or electric knife to fully remove the entire free ends can be closed lymphatic vessels, thus reducing the leakage of lymph. Axillary and chest wall surgery and negative pressure wound dressing inaccurate poor drainage, postoperative upper limbs on the move, outreach, especially early induced axillary flap flap also contributed to poor fixed a few seroma kinds of factors. After dressing well, to adjust the location of drainage pipes and pressure to maintain drain patency, early braking can significantly reduce the upper limbs the incidence of postoperative lymph leakage.
Breast Surgery Complications (e) upper limb dysfunction
Modified radical mastectomy, patients with skin flap and chest wall surgery in the close adhesion, can affect the upper limb function in some patients. Most of the postoperative function after exercise can be recovered. However, if on extended axillary incision, intraoperative neurovascular protection, then the absence of upper limb function after surgery significantly affected side, mainly on the ipsilateral upper extremity move is not enough, insufficient outreach. Long thoracic nerve injury can cause a typical wing-like shoulder performance. Therefore, the intraoperative anatomic structure should be protected.
(F) upper extremity edema
Mostly upper extremity edema refractory vascular surgery after nerve preservation is not enough collateral circulation caused by inadequate lymphatic drainage due to obstruction. Tight bandaging after surgery, subcutaneous fluid, wound infection, upper extremity edema can be, but can be significantly improved after treatment. Axillary vascular surgery leather Shaw reserves the axillary vessels to maintain the appropriate tension, can reduce the incidence of upper extremity edema.
(Vii) breast size of the muscle atrophy
Breast surgery nerve and accompanying blood vessels can cause thoracic injuries large and small muscle atrophy. Occurred in the three months after surgery, and showed progressive development. Until the only part of the medial pectoral cord Shao.
Surgical complications of breast cancer treatment, (h) surgical field around the chest wall and upper limb paresthesia to shoulder in the free flap surgery and removal of the axillary nerve and the skin when the skin caused by nerve cut. The course of time can be enlarged nerve stump, the patient can be seen in the surgical field sting or a jump discontinuity, the region a sense of pain.
- axillary flap removal
- collateral circulation is nessary to preventcomplication caused by the what
- mastectomy suture line necrosis care