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Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report
BACKGROUND: Rhabdomyolysis is a potentially fatal clinical syndrome resulting from the damage or breakdown of skeletal muscle, which can also lead to permanent disabilities. Based on our review of studies on rhabdomyolysis after prolonged surgeries, no other cases of rhabdomyolysis caused by muscle...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506112/ https://www.ncbi.nlm.nih.gov/pubmed/37727339 http://dx.doi.org/10.21037/gs-23-8 |
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author | Kang, Myeong Jae Cho, Hyun Geun Lim, Jeong-Hoon Byun, Sung-Hye Lee, Su-Hyun Kang, Byeongju Lee, Jeeyeon Park, Ho Yong Ryu, Jeong Yeop Choi, Kang Young Yang, Jung Dug Chung, Ho Yun Cho, Byung Chae Lee, Joon Seok |
author_facet | Kang, Myeong Jae Cho, Hyun Geun Lim, Jeong-Hoon Byun, Sung-Hye Lee, Su-Hyun Kang, Byeongju Lee, Jeeyeon Park, Ho Yong Ryu, Jeong Yeop Choi, Kang Young Yang, Jung Dug Chung, Ho Yun Cho, Byung Chae Lee, Joon Seok |
author_sort | Kang, Myeong Jae |
collection | PubMed |
description | BACKGROUND: Rhabdomyolysis is a potentially fatal clinical syndrome resulting from the damage or breakdown of skeletal muscle, which can also lead to permanent disabilities. Based on our review of studies on rhabdomyolysis after prolonged surgeries, no other cases of rhabdomyolysis caused by muscle injury in the buttock area following breast reconstruction have been reported, making the current report the first to share information related to patient conditions and treatment progress in such cases. CASE DESCRIPTION: Here, we present the case of a 57-year-old Asian patient with left breast cancer. We performed immediate breast reconstruction using a deep inferior epigastric perforator (DIEP) flap anastomosed to the internal mammary vessels after a skin-sparing mastectomy with sentinel lymph node biopsy. The surgery exceeded the estimated time because, after anastomosis, severe congestion was observed in the flap and because of the need to perform re-anastomosis and the reconstruction of the internal mammary vein twice. The surgical team eventually re-performed the breast reconstruction using a contralateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap. The patient underwent breast reconstruction in a sitting position to ensure a symmetrical and natural breast shape resembling its original state. Additionally, a brown splint was placed underneath both legs to keep the hip and knees flexed to ensure donor-site closure when using an abdominal-based flap. The patient was closely monitored in the early postoperative period. On postoperative day (POD) 3, patient developed hypotension and was deemed to have experienced a hypovolemic shock. A complete laboratory workup was performed, and a rhabdomyolysis diagnosis was made based on the laboratory results. We believe that rhabdomyolysis resulted from prolonged pressure on the large gluteus maximus muscle located below the site of the pressure sore in the present patient. CONCLUSIONS: Postoperative rhabdomyolysis often results from prolonged surgery. Given the possibility of prolonged procedure time in patients undergoing breast reconstruction, the current case emphasizes the need to identify each patient’s risk factors for rhabdomyolysis and prepare for possible rhabdomyolysis to prevent ischemic injuries and reduce the risk of complications such as hypovolemic shock. |
format | Online Article Text |
id | pubmed-10506112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-105061122023-09-19 Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report Kang, Myeong Jae Cho, Hyun Geun Lim, Jeong-Hoon Byun, Sung-Hye Lee, Su-Hyun Kang, Byeongju Lee, Jeeyeon Park, Ho Yong Ryu, Jeong Yeop Choi, Kang Young Yang, Jung Dug Chung, Ho Yun Cho, Byung Chae Lee, Joon Seok Gland Surg Case Report BACKGROUND: Rhabdomyolysis is a potentially fatal clinical syndrome resulting from the damage or breakdown of skeletal muscle, which can also lead to permanent disabilities. Based on our review of studies on rhabdomyolysis after prolonged surgeries, no other cases of rhabdomyolysis caused by muscle injury in the buttock area following breast reconstruction have been reported, making the current report the first to share information related to patient conditions and treatment progress in such cases. CASE DESCRIPTION: Here, we present the case of a 57-year-old Asian patient with left breast cancer. We performed immediate breast reconstruction using a deep inferior epigastric perforator (DIEP) flap anastomosed to the internal mammary vessels after a skin-sparing mastectomy with sentinel lymph node biopsy. The surgery exceeded the estimated time because, after anastomosis, severe congestion was observed in the flap and because of the need to perform re-anastomosis and the reconstruction of the internal mammary vein twice. The surgical team eventually re-performed the breast reconstruction using a contralateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap. The patient underwent breast reconstruction in a sitting position to ensure a symmetrical and natural breast shape resembling its original state. Additionally, a brown splint was placed underneath both legs to keep the hip and knees flexed to ensure donor-site closure when using an abdominal-based flap. The patient was closely monitored in the early postoperative period. On postoperative day (POD) 3, patient developed hypotension and was deemed to have experienced a hypovolemic shock. A complete laboratory workup was performed, and a rhabdomyolysis diagnosis was made based on the laboratory results. We believe that rhabdomyolysis resulted from prolonged pressure on the large gluteus maximus muscle located below the site of the pressure sore in the present patient. CONCLUSIONS: Postoperative rhabdomyolysis often results from prolonged surgery. Given the possibility of prolonged procedure time in patients undergoing breast reconstruction, the current case emphasizes the need to identify each patient’s risk factors for rhabdomyolysis and prepare for possible rhabdomyolysis to prevent ischemic injuries and reduce the risk of complications such as hypovolemic shock. AME Publishing Company 2023-06-29 2023-07-31 /pmc/articles/PMC10506112/ /pubmed/37727339 http://dx.doi.org/10.21037/gs-23-8 Text en 2023 Gland Surgery. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Case Report Kang, Myeong Jae Cho, Hyun Geun Lim, Jeong-Hoon Byun, Sung-Hye Lee, Su-Hyun Kang, Byeongju Lee, Jeeyeon Park, Ho Yong Ryu, Jeong Yeop Choi, Kang Young Yang, Jung Dug Chung, Ho Yun Cho, Byung Chae Lee, Joon Seok Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title | Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title_full | Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title_fullStr | Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title_full_unstemmed | Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title_short | Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
title_sort | catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506112/ https://www.ncbi.nlm.nih.gov/pubmed/37727339 http://dx.doi.org/10.21037/gs-23-8 |
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