Abstract: This article is a review of fat grafting for breastreconstruction... the correction of step-off deformities, intrinsic deformities, and extrinsic deformities of the breast, and the uses of large volume fat grafting for total breastreconstruction, correction of implant complications with simultaneous implant exchange with fat, and correction of ...
BACKGROUND: The double capsule is a complication mostly described in aggressive macrotextured implants. Mechanical shear stress applied onto an immature periprosthetic capsule has been linked to their formation. The authors aim to demonstrate the role of bacterial phenotype and biofilm in the development of the double capsule.
METHODS: Seven double capsules formed at the interface of macrotextured breast expander implants were studied using scanning electron microscopy. Two samples for each surface of the inner capsule layer (the prosthesis interface and the intercapsular space) were analyzed for bacteria cell size, bacterial density, and biofilm deposition.
RESULTS: Although all routine bacterial cultures were negative, the prosthesis interface had both higher bacteria load and biofilm deposition compared with the intercapsular space (Mann-Whitney U test, p = 0.004 and p = 0.008, respectively). Moreover, bacteria cell sizes were significantly smaller at the prosthesis interface in six of seven samples. Comparison of bacteria density and biofilm dispersion showed an increase of biofilm extracellular matrix deposition over 2000 cells/mm (linear regression, p = 0.0025). These results indicate a common trend among bacteria species.
CONCLUSIONS: Bacterial expression between the different surfaces of the double capsule displays significant differences; bacteria at the prosthesis interface are mostly in a biofilm state, whereas they demonstrate a planktonic phenotype at the intercapsular space. When a sufficient amount of bacteria are present at a specific location, quorum sensing may trigger a biofilm phenotypic switch in planktonic bacteria cells. Biofilm formation may alter capsule formation through immune response, thereby weakening capsule strength and facilitating extracellular matrix delamination and double-capsule formation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
Traditional methods for prosthetic breastreconstructions have utilized total or partial muscle coverage of prosthetic devices ... Prepectoral prosthetic breastreconstruction has gained popularity in the plastic surgery community, and long-term outcomes have become available ... This article will review the indications, technique, and current literature surrounding prepectoral prosthetic breastreconstruction.
Oncology (2) Breast Neoplasms (3), Muscle Spasm (1), more mentions
DescriptorName: Tissue Scaffolds. Abstract: Of the nearly 90,000 implant-based breastreconstructions performed in the United States, the majority use internal soft-tissue support. Aesthetically, these constructs may allow for better positioning of prosthesis, improve lower pole expansion, and increase projection. They may have particular utility in direct-to-implant, nipple-sparing mastectomies, and prepectoral reconstructions.
Abstract: Postmastectomy immediate breastreconstruction in the U.S. continues to experience an upward trend owing to heightened awareness, innovations in reconstructivetechnique, growing evidence of improved patient-reported outcomes, and shifts in ... use of radiation as an adjuvant treatment for management of breast cancer has created additional challenges for plastic surgeons who need to consider the optimal timing and method of breastreconstruction to perform in these patients ...
Abstract: Prosthetic reconstruction utilizing a 2-stage saline tissue expander-to-implant procedure is the most common technique for breastreconstruction in the United States. For nearly the past 50 years, 2-stage breastreconstruction using saline tissue expanders has been the standard of care. However, in December 2016, a carbon dioxide-filled, remote-controlled tissue expander received U.S ...
AbstractText: Direct-to-implant breastreconstruction offers time-saving advantages over two-stage techniques. However, use of direct-to-implant reconstruction remains limited, in part, because of concerns over complication rates., The authors' aim was to compare 2-year complications and patient-reported outcomes for direct-to-implant versus tissue expander/implant reconstruction AbstractText: Patients undergoing immediate direct-to-implant ...
RATIONALE: The nasoseptal flap has been widely used to reconstruct skull base defects with excellent success rates. Recently, there were several attempts to use this flap for other defects. Patient concerns: We present the case of the nasoseptal flap reconstruction after oropharyngeal cancer resection.
DIAGNOSIS: The diagnosis of this patient was oropharyngeal T3 squamous cell carcinoma.
INTERVENTIONS: The surgical resection included the right radical tonsillectomy, uvular, and part of the soft palate and hard palate. The nasoseptal flap was sutured to the oropharyngeal defect.
OUTCOMES: In spite of the radiation therapy, the nasoseptal flap was well healed to the oropharyngeal defect.
LESSONS: We suggest that the nasoseptal flap may be a feasible reconstruction option for oropharyngeal defect after oropharyngeal cancer resection.
RATIONALE: Gustatory otorrhea can lead to cutaneous changes, recurrent infection, and social disruption. We present a case of a late, evolving sialocutaneous fistula to the external auditory canal, managed surgically after failing conservative therapies. This case is unique by late evolution, whereby the symptoms presented with significance 27 years after her operation and 19 years after mild symptoms initially arose.
PATIENT CONCERNS: Gustatory, left-sided clear otorrhea with acutely increased volume over 8 months causing social disruption.
DIAGNOSES: Sialocutaneous fistula to the external auditory canal.
INTERVENTIONS: Superficial parotidectomy and temporoparietal flap for closure of fistula.
OUTCOMES: No postoperative complications and resolution of gustatory otorrhea at one-year follow-up.
LESSONS: This rare, but important, postoperative complication can present late with evolving symptoms, causing significant social disruption. It can be treated with conservative medical management and several surgical approaches.
Fistula (4), Infections (1), Salivary Gland Fistula (1), more mentions
Abstract: The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breastreconstruction with abdominal flaps ... guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy ...
Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program AbstractText: This is a preintervention and postintervention ... to 32 of 35 (91.4 percent) (p < 0.001) AbstractText: An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents ...
RATIONALE: Pelvic malunion is a rare complication and is technically challenging to correct owing to the complex three-dimensional (3D) geometry of the pelvic girdle. Hence, precise preoperative planning is required to ensure appropriate correction. Reconstructive surgery is generally a 2- or 3-stage procedure, with transiliac osteotomy serving as an alternative to address limb length discrepancy.
PATIENT CONCERNS: A 38-year-old female patient with a Mears type IV pelvic malunion with previous failed reconstructive surgery was admitted to our department due to progressive immobilization, increasing pain especially at the posterior pelvic arch and a leg length discrepancy. The leg discrepancy was approximately 4 cm and rotation of the right hip joint was associated with pain.
DIAGNOSIS: Radiography and computer tomography (CT) revealed a hypertrophic malunion at the site of the previous posterior osteotomy (Mears type IV) involving the anterior and middle column, according to the 3-column concept, as well as malunion of the left anterior arch (Mears type IV).
INTERVENTIONS: The surgery was planned virtually via 3D reconstruction, using the patient's CT, and subsequently performed via transiliac osteotomy and symphysiotomy. Finite element method (FEM) was used to plan the osteotomy and osteosynthesis as to include an estimation of the risk of implant failure.
OUTCOMES: There was not incidence of neurological injury or infection, and the remaining leg length discrepancy was ≤ 2 cm. The patient recovered independent, pain free, mobility. Virtual 3D planning provided a more precise measurement of correction parameters than radiographic-based measurements. FEM analysis identified the highest risk for implant failure at the symphyseal plate osteosynthesis and the parasymphyseal screws. No implant failure was observed.
LESSONS: Transiliac osteotomy, with additional osteotomy or symphysiotomy, was a suitable surgical procedure for the correction of pelvic malunion and provided adequate correction of leg length discrepancy. Virtual 3D planning enabled precise determination of correction parameters, with FEM analysis providing an appropriate method to predict areas of implant failure.
Previous scars, amount of weight loss, operative time, liposuction, and other concurrent procedures did not affect total complications. Male sex (OR, 1.96; p = 0.04), fleur-de-lis technique (OR, 1.71; p = 0.04), and medial thigh lift (OR, 3.3; p < 0.001) were independent risk factors for total postoperative complications AbstractText: This study demonstrates that abdominoplasty alone or in combination with liposuction ...
DescriptorName: Mammaplasty. DescriptorName: Myocutaneous Flap. DescriptorName: Perforator Flap. DescriptorName: Thigh. Abstract: Thigh-based flaps are typically a secondary option for breastreconstruction because of concerns regarding limited tissue volume and donor-site morbidity... With careful planning and selection, thigh-based flaps can provide a reliable option patients desiring autologous breastreconstruction.
Abstract: Breastreconstruction following mastectomy has evolved to preserve the native skin and nipple of the breast and create a natural-appearing reconstruction in 1 or 2 surgeries ... Thus, nipple-sparing mastectomy and direct-to-implant breastreconstruction is emerging as a preferred method of breastreconstruction when the breast skin envelope is sufficiently perfused ...
Oncology (2), Pain Management (1) Neoplasms (2), Breast Neoplasms (1), more mentions
Abstract: With the indications for radiation therapy in the treatment of breast cancer continuing to expand, many patients present for reconstruction having previously had radiation or having a high likelihood of requiring radiation following mastectomy. Both situations are challenging for the plastic surgeon, with different variables impacting the surgical outcome.
AbstractText: Modern breastreconstruction often involves microvascular reconstruction... An equally important aspect is internal mammary vessel preparation AbstractText: Breastreconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016 ... In 97.6 percent of these breastreconstructions, the internal mammary vessels were used... In modern breastreconstruction, the internal mammary artery and vein are typically used.
Describe eyelid anatomy and demonstrate full understanding of the critical structures and basic principles of eyelidreconstruction ... design effective strategies to manage and treat common complications following eyelidreconstruction AbstractText: Defects of the eyelid can result from trauma, burns, or resection of cutaneous malignancies ... Repair of eyelid defects presents unique challenges to reconstructive surgeons.
In both groups, the reconstructed ala was thicker than that on the normal side, the reconstructed nostril was smaller than the normal nostril, and the reconstructed hemi-nose was bigger than the normal side ... All the patients were satisfied with their total nasal appearance AbstractText: The FFF showed objective, subjective, aesthetic, and functional results comparable to other lining reconstructiontechniques Keyword: Folded forehead flap ...