Prophylactic Buried Dermal Flap with Immediate Lymphatic Reconstruction: Effect on Functional Outcomes after Axillary Lymph Node Dissection.

Abstract

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. 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. 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. 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.