European Journal of Surgical Oncology | 2021
Covid-19 crisis promotes innovation: The extended indications for pedicled perforator flaps in breast cancer surgery.
Abstract
Background: During the height of the Covid-19 pandemic in the United Kingdom (March-May 2020) the use of implants and DIEP flaps was prohibited to avoid extended patient in-hospital stay and exposure to risk Due to a requirement to innovate, we increased our use of local pedicled perforator flaps (PPF) to optimise wide excision allowing for clear margins and replacing tissue to maintain cosmesis and also to provide whole breast reconstruction whilst minimising length of hospital stay (LOS) and risk of complications requiring readmission We report the early outcomes from these cases Materials and Methods: We audited a prospective database of patients who had a single-stage local pedicled perforator flap (PPF) as part of their breast cancer surgery at The Royal Marsden Breast Unit during the peak incidence period for London of the Covid-19 pandemic Results: Seventeen female patients (median age (IQR) = 56years (53-63), BMI 26 3 kg/m2 (23 5-28 6) and 3 were current smokers) had a PPF for the following indications: resurfacing for locally-advanced breast cancer (LABC) without muscle, (n=2), small local recurrence after previous BCS and radiotherapy (n=2), whole breast autologous reconstruction (n=3) and volume replacement as part of BCS (n=10) Median resection specimen weight was 167g (IQR 51-208) LOS for 16 of the 17 was less than 36 hours and only 1 patient had unplanned return to surgery for ischaemia of a small area of the distal flap (debridement and closure, day surgery) 8 days after initial surgery The median tumour extent was 57mm (IQR 41-71mm) and no BCS patients had involved margins and all patients made uneventful recovery Median follow-up is 12 7 weeks (minimum 30 days) and 12 patients have undergone adjuvant radiotherapy with 6 having adjuvant chemotherapy Longer-term follow-up will be undertaken for oncological and patient-reported outcomes (914) Ten out of 17 had pre-operative Covid-19 swab tests which were all negative and no patient had acquired Covid-19 at 28 days post-surgical follow-up Conclusions: Short-term follow-up demonstrated feasibility and safety of extending the indications for single-stage PPF surgery in selected breast cancer patients including whole breast autologous reconstruction and resurfacing for LABC whilst safely minimising LOS Times of heightened risk such as the Covid-19 pandemic can provide opportunities for innovation for patient benefit