Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction.docVIP

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Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction.doc

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Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction

CeletOzdenetal.WorldJournalofSurgicalOncology2012,10:44 /content/10/1/44 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH OpenAccess Doespartialexpanderdeflationexacerbatethe adverseeffectsofradiotherapyintwo-stage breastreconstruction? BurcuCeletOzden ,ErdemGuven ,IsikAslay,GonulKemikler ,VakurOlgac ,MervaSolukTekkesin4, 1* 1 2 3 4 BengulSerarslan ,BurcakTumerdemUlug,AylinBilginKarabulut ,AtillaArinci andUfukEmekli1 2 5 1 1 Abstract Background:Theoptimumprotocolforexpandervolumeadjustmentwithrespecttothetimingandapplication ofradiotherapyremainscontroversial. Methods:EighteenNewZealandrabbitsweredividedintothreegroups.Metallicportintegratedanatomicbreast expandersof250ccwereimplantedonthebackofeachanimalandcontrolledexpansionwasperformed.GroupI underwentradiotherapywithfullexpanderswhileinGroupII,expanderswerepartiallydeflatedimmediatelyprior toradiotherapy.Controlgroupdidnotreceiveradiotherapy. ThechangesinbloodflowatdifferentvolumeadjustmentswereinvestigatedinGroupIIbylaserDoppler flowmetry.Variationsinthehistopathologicpropertiesoftheirradiatedtissuesincludingtheskin,capsuleandthe pocketfloor,werecomparedinthebiopsyspecimenstakenfromdifferentlocationsineachgroup. Results:AsignificantincreaseinskinbloodflowwasdetectedinGroupIIwithpartialexpanderdeflation.Overall, histopathologicexamrevealedaggravatedfindingsofchronicradiodermatitis(epidermalatrophy,dermal inflammationandfibrosis,neovascularisationandvascularchangesaswellasincreasedcapsulethickness) especiallyaroundthelowerexpanderpole,inGroupII. Conclusions:Expanderdeflationimmediatelypriortoradiotherapy,mayaugmenttheadverseeffects,especiallyin thelowerexpanderpole,possiblyviaenhancedradiosensitizationduetoarelativeincreaseinthebloodflowand tissueoxygenation. Keywords:Two-stagebreastreconstruction,Radiotherapy,Tissueexpansion Background application ofradiotherapy (RT)remains controversial. Tissueexpanderassistedtwo-stagebreastreconstruction WhiledeflationoftheexpanderatthetimeofRThelps has been success