Current Issue : October - December Volume : 2011 Issue Number : 1 Articles : 6 Articles
Background: In this study, a new fasciocutaneous perforator flap raised from inner medial surface of the distal medial arm has been described for soft tissue coverage. Methods: The blood supply of this flap comes directly from the distal brachial artery. Fourteen limbs of 7 formalinized cadavers were dissected to study the origin and the course of perforator vessel. Results: The average size of the flap was 10.7 cm Ã?â?? 5.6 cm in the distal medial arm region. The constant main perforator was measured within a circle of 2.76-cm diameter, the center of which was 11.5 cm above and 1.3 cm medial to the medial epicondyle of humerus. The mean length and diameter of the distal brachial perforator artery were 3.3 cm and 0.95 mm, respectively. Conclusion: We think that this flap may be a useful option for the reconstruction of soft tissue defect of elbow....
Objectives: Upper extremity reconstruction presents a functional and aesthetic challenge in plastic surgery. Exposure of vital structures often requires vascularized soft tissue coverage to achieve primary wound healing and optimize functional results. Specifically, the serratus fascial flap may satisfy the functional and cosmetic requirements for small- to medium-sized soft tissue defects of the upper extremity with limited donor site morbidity. We describe our technique of serratus fascial flap harvest, using the Harmonic SYNERGY curved blade (Ethicon Endo-Surgery, Cincinnati, Ohio). Material and Methods: A 21-year-old, right-hand-dominant, male carpenter and martial arts expert was involved in a motorcycle collision and sustained a left-hand dorsal degloving injury and extensor tendon rupture. Soft tissue reconstruction was performed with a serratus fascial free flap, immediate split-thickness skin graft, and palmaris longus tendon grafts. The flap was harvested with the Harmonic blade, which utilizes ultrasonic energy translated into mechanical energy, thereby allowing dissection and hemostasis simultaneously. Results: Flap elevation proceeded facilely using the Harmonic curved blade. The patient had no postoperative complications involving his flap or donor site. The closed suction drain in the donor site was removed on postoperative day 3, and the patient was discharged on postoperative day 10. The patient is doing well at 4 months follow-up. Conclusion: The Harmonic blade may assist in the dissection of the serratus fascial flap by aiding with hemostasis and minimizing surrounding tissue damage. This may reduce flap damage associated with harvesting techniques as well as decrease donor site seroma formation....
Background\nPhyllodes tumors are uncommon tumors of the breast that exhibit aggressive growth. While surgical management of the tumor has been reported, a single surgical approach with immediate breast reconstruction using AlloDerm has not been reported.\n \nCase presentation\nA 22-year-old woman presented with a 4 cm mass in the left breast upon initial examination. Although the initial needle biopsy report indicated a fibroadenoma, the final pathologic report revealed a 6.5 cm Ã?â?? 6.4 cm Ã?â?? 6.4 cm benign phyllodes tumor ex vivo. Treatment was a simple nipple-sparing mastectomy coupled with immediate breast reconstruction. After the mastectomy, a subpectoral pocket was created for a saline implant and AlloDerm was stitched to the pectoralis and serratus muscle in the lower-pole of the breast.\n \nConclusions\nSaline implant with AlloDerm can be used for immediate breast reconstruction post-mastectomy for treatment of a phyllodes tumor....
Objective: The role for acellular dermal matrix in implant-based breast reconstructionââ?¬â?providing coverage of the inferolateral border of the underlying prosthesis and allowing control over the inframammary foldââ?¬â?has become increasingly popular. Although AlloDerm (LifeCell, Branchburg, NJ) is free of cellular components responsible for the antigenic response, its processing does not guarantee sterility. In this study, we examine the infectious complications in tissue expander/implant-based reconstruction with AlloDerm. Methods: A retrospective cohort analysis was completed on 321 implant-based breast reconstructions over a 10-year period (1998ââ?¬â??2008) at an academic institution. Of these cases, 75 reconstructions used AlloDerm and 246 reconstructions did not. The incidence of infections that required readmission for intravenous (IV) antibiotics and explantation was determined. Prosthetic explants due to hematoma or patient dissatisfaction were excluded from analysis. Results: There were no differences in rates of readmission for IV antibiotics (2.8% vs 5.3%; P = .291). The rate of explantation due to infected fluid collections and extrusion was higher in the AlloDerm group (8.0%, n = 6) than that in the control group (1.6%, n = 4). This result was statistically significant (P = .013). Conclusion: In this study, the rates of IV antibiotic administration for the treatment of cellulitis in implant-based breast reconstructions did not differ because of the presence of AlloDerm; however, the rate of explantation was statistically higher in reconstructions using AlloDerm. This technique has great potential in breast reconstruction, especially for single-staged implant-based reconstruction, but careful counseling of patients with regard to the higher risk of explantation is necessary....
Objectives. Several modalities have been advocated to treat traumatic scars, including surgical techniques and laser resurfacing. Recently, a plasma skin regeneration (PSR) system has been investigated. There are no reports on plasma treatment of mesh skin grafted scars. The objective of our study is to evaluate the effectiveness and complications of plasma treatment of mesh skin grafted scars in Asian patients. Materials and Methods. Four Asian patients with mesh skin grafted scars were enrolled in the study. The plasma treatments were performed at monthly intervals with PSR, using energy settings of 3 to 4?J. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 months post treatment. The patients were also evaluated for any side effects from the treatment. Results. All patients showed more than 50% improvement. The average pain score on a 10-point scale was 6.9 +/- 1.2?SD and all patients tolerated the treatments. Temporary, localized hypopigmentation was observed in two patients. Hyperpigmentation and worsening of scarring were not observed. Conclusions. Plasma treatment is clinically effective and is associated with minimal complications when used to treat mesh skin grafted scars in Asian patients....
Background\nBreast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume of the resected breast tissue being the major determinant. There is clear evidence for the efficacy of ultrasonography in the resection of nonpalpable tumours. Surgical resection of palpable breast cancer is performed with guidance by intra-operative palpation. These palpation-guided excisions often result in an unnecessarily wide resection of adjacent healthy breast tissue, while the rate of tumour-involved resection margins is still high. It is hypothesised that the use of intra-operative ultrasonography in the excision of palpable breast cancer will improve the ability to spare healthy breast tissue while maintaining or even improving the oncological margin status. The aim of this study is to compare ultrasound-guided surgery for palpable tumours with the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumour-free margins, cosmetic outcomes and quality of life.\n \nMethods/design\nIn this prospective multicentre randomised controlled clinical trial, 120 women who have been diagnosed with palpable early-stage (T1-2N0-1) primary invasive breast cancer and deemed suitable for breast-conserving surgery will be randomised between ultrasound-guided surgery and palpation-guided surgery. With this sample size, an expected 20% reduction of resected breast tissue and an 18% difference in tumour-free margins can be detected with a power of 80%. Secondary endpoints include cosmetic outcomes and quality of life. The rationale, study design and planned analyses are described.\n \nConclusion\nThe COBALT trial is a prospective, multicentre, randomised controlled study to assess the efficacy of ultrasound-guided breast-conserving surgery in patients with palpable early-stage primary invasive breast cancer in terms of the sparing of breast tissue, oncological margin status, cosmetic outcomes and quality of life....
Loading....