Publications by authors named "Saori Kanagawa"

2 Publications

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Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation.

Int J Surg Case Rep 2021 Apr 5;82:105860. Epub 2021 Apr 5.

Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara, 634-8522, Japan. Electronic address:

Introduction: Implant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].

Presentation Of Case: A 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.

Discussion: Factors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.

Conclusion: Intermittent suction worked well in this patient and, thus, warrants further study.
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April 2021

Squamous cell carcinoma developed in a chronic radiation-induced chest wall ulcer that is difficult to undergo thorough preoperative histological examination.

Int J Surg Case Rep 2020 17;72:467-470. Epub 2020 Jun 17.

Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.

Introduction: We report a case in which squamous cell carcinoma (SCC) developed in a large chronic radiation-induced thoracic ulcer after flap surgery in areas where preoperative histological examinations are difficult.

Presentation Of Case: The patient was a 75-year-old female. She had undergone resection and radiotherapy for left breast cancer 15 years earlier. Six years ago, the ulcer expanded from the subclavian to xiphoid levels, exposing the lung and pericardium. A histopathological examination, which avoided the lung and pericardium, was performed. Inflammation was diagnosed. We reconstructed the chest wall with a pedicled rectus abdominis flap. Eighteen months later, three verrucous tissue-lined fistulas formed. A histological examination revealed well-differentiated SCC. Six months later, the patient died of massive bleeding from a fistula.

Discussion: It is unclear exactly when the SCC occurred. As three fistulas formed at the margins of the flap around the pericardium, we suspect that the cancer developed within or near the pericardial region. We need to reflect on the lack of a thorough biopsy. As no pericardial biopsy was performed, we should have asked a thoracic/cardiac surgeon to conduct a biopsy during the debridement operation. If the tumor had been localized to the pericardium, it could have been removed.

Conclusion: It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors.
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June 2020