We report a case of dedifferentiated chondrosarcoma of the chest wall. After resection, the chest wall defect was reconstructed using polypropylene mesh and a transverse rectus abdominis myocutaneous flap. A 61-year-old woman presented with a 16-year history of a slow-growing mass underneath the right chest wall. After percutaneous ...
PubMed
Harvesting the rectus abdominis myocutaneous flap results in defects in both the rectus abdominis muscle and the anterior rectus sheath, which may be circumvented by dissecting a perforator flap (DIEP flap) instead. However, the latter is associated with a reduction in the ...
A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible ...
Breast conserving surgery for breast cancer has led to an increased interest in reconstruction following mastectomy. The transverse rectus abdominis myocutaneous flap has been proven to give good results in terms of restoration of body symmetry with near normal contour and consistency. Furthermore, immediate reconstruction has the ...
PubMed Central
Abdominal wall herniation is a relatively rare but well recognized complication that is known to occur following TRAM flap mobilization. Herein is presented a novel means to approach such a hernia, using the minimally invasive surgical approach to repair the defect with a piece of prosthetic material. PMID:9774021
An alternative treatment for low rectal cancer is the extended posterior perineal approach with reconstruction of the pelvic floor (cylindrical technique). Pelvic floor defects often require flap reconstruction using gracilis flaps, vertical rectus abdominis myocutaneous flaps or local ...
Inadequate blood supply of pedicle flaps results in partial necrosis, and prolonged ischemia during free-tissue transfer can result in partial or complete flap necrosis. Recent research in the field of cardiovascular surgery has shown that ischemic preconditioning (repeated brief episodes of coronary artery occlusion followed by reperfusion) improves ...
Extremely large chest wall defects may result following salvage oncological surgery. Typically these defects involve a large skin defect combined with a variable resected area of underlying muscle and ribs. In situations where the skin defect is very large the use of a large latissimus dorsi flap may require skin grafting to the donor site if a ...
In rectus abdominis myocutaneous island flaps (3.0 x 1.5 cm) of 86 rats (Uje: WIST) transcutaneous oxygen tension measurements (tcPO2) were made by a Universal-PO2-Meter MO 10.1 (PRACITRONIC, Dresden, GDR) for monitoring flap viability following blood flow insufficiency produced experimentally. This insufficiency ...
BACKGROUND: In our own experience over the last 15�years, the primary transpelvic vertical rectus abdominis myocutaneous (VRAM) flap is a reliable tool to prevent perineal wound complications after cylindrical excision in radical anorectal tumor surgery. To minimize the operative trauma in such patients, we performed a laparoscopic ...
BACKGROUND: Closure of donor-site defects from large cutaneous flap harvesting often faces significant morbidity, which limits the utility of workhorse flaps in large-soft-tissue defect reconstruction. To overcome this limitation, we introduced the concept of a second 'buddy' flap to reconstruct the donor-site defect. METHODS: Between ...
In defect reconstruction following radical oncologic resection of malignant chest wall tumors, adequate soft-tissue reconstruction must be achieved along with function, stability, integrity, and aesthetics of the chest wall. The purpose of this retrospective analysis was to evaluate the oncoplastic concept following radical resection of malignant chest wall infiltration with an interdisciplinary ...
IntroductionBreast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site.Case presentationWe report the case of a woman who had bilateral transverse rectus abdominis ...
The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a popular choice for patients requesting breast reconstruction. Criticism of all techniques that harvest the rectus abdominis muscle centre on abdominal wall weakness.[Dulin WA, Avila RA, Verheyden CN, Grossman L. Evaluation of abdominal wall ...
Tumors of the gluteal region are rare. Defects from resection often can be closed primarily. Some patients require local flaps such as a gluteus maximus V-Y advancement flap. Such flaps typically result in some muscle dysfunction. In addition, the use of local irradiated tissue may lead to wound complications and prolonged ...
Knee reconstruction with endoprosthesis after tumor resection is accepted as superior when compared with the other methods. But sometimes soft tissue reconstruction would be a challenging problem in this way of treatment. Five patients who were operated for tumor resection in this location, followed by reconstruction were presented with their one-year post operative results. Four latissimus dorsi ...
Microvascular flap surgery is a common technique in reconstructive surgery. The wide indications and variable patients provide challenge also for anesthesiologist. Both hypotension and hypoperfusion can be harmful to the flap. Hypotensive patients are treated with fluid resuscitation and vasopressors (e.g., norepinephrine), if needed. As vasoconstrictors, ...
The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and ...
SUMMARYDesmoid tumor is a rare, benign fibroblastic tumor that is characterized by highly aggressive local invasiveness.The authors report the case of a 35 year old male who presented with a 20 cm para-umbilical tumor invading the right rectus abdominis muscle. This required a wide excision of the abdominal wall. The resulting defect was closed with a single-stage latissimus ...
BackgroundAlthough multiple strategies for autologous breast reconstruction exist, a vertical midline scar in the abdominal wall as a result of previous laparatomy or abdominoplasty represents a major surgical challenge. To date, little research has been conducted on the regeneration potential of the abdominal wall�s superficial vascular, perforator and choke vessel system after surgery using a ...
BACKGROUND:: Performing a sacrectomy from an exclusively posterior approach allows for the en bloc resection of tumors without the morbidity of a laparotomy. However, the reconstruction of the resultant extensive soft-tissue defects is challenging, as a vertical rectus abdominis myocutaneous flap is not harvested. OBJECTIVE:: We report ...
The authors retrospectively reviewed the computerized records of 71 women undergoing 80 deep inferior epigastric perforator (DIEP) flap reconstructions after mastectomy over a 1-year period. There were 33 normal, 26 overweight, and 12 obese patients. No statistically significant difference in flap complications was found between groups. Overall fat ...
Closure of fascia after transverse rectus abdominis myocutaneous (TRAM) flap has usually been performed with direct closure or synthetic material. The dermal autograft removed from zone IV of the flap is an alternative to reinforce fascial closure. Record of the patients who had been undergone breast and head and ...
Breast cancer is a common cancer among women. The transverse rectus abdominis myocutaneous (TRAM) flap is a popular option because not only does it provide a breast with satisfactory bulk composed of autogenous tissue but it also provides an abdominal dermolipectomy to the patient. Fat necrosis remains a common problem following TRAM ...
In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by ...
Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, ...
During recent years, clinical research on the donor site morbidity after free or pedicled transverse rectus abdominis myocutaneous (TRAM) flap surgery has been focusing on the reduced flexion capacity of the abdominal wall. However, the rectus abdominis muscles have close interactions with their synergists and ...
We have reviewed all the cases of flap reconstruction following resection of a gynaecological malignancy at the Royal Marsden Hospital over 12 years from 1993 until 2005. Forty-six patients were identified who required 53 flaps. The predominant site of the primary tumour was vulva, accounting for 83% of the cases, with cervix, ovary, vagina and endometrium ...
Coverage of large defects of the soft tissue of the groin present a challenging problem. Exposure of the femoral vessels or prosthetic grafts requires urgent coverage with well vascularized tissue. The medial and lateral femoral circumflex arteries supply the gracilis, sartorius, vastus lateralis, rectus femoris and tensor fascia lata muscles, permitting the use of these muscles or ...
Full-thickness chest wall resection is performed for complete removal of primary and secondary malignant chest wall tumors. Large defects of the chest wall after resection must be repaired to maintain adequate ventilation, to protect important intrathoracic structures, and to preserve cosmetic integrity. Various materials have been utilized over the years to replace the rigid chest wall. At ...
This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the ...
The most common complication after abdominoplasty is seroma formation. The incidence of seroma formation in abdominal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from 1% to 38%. A recent concern among surgeons is the possibility of a ...
Wide, complex defects of the scalp caused by various insults always represent reconstructive challenges for surgeons. Our study group consisted of 18 patients (14 males and 4 females) with a mean age of 40.2 years. Nineteen free-tissue transfers were used to reconstruct the scalp defects. The selected cases included 8 latissimus dorsi muscle flaps, 3 latissimus dorsi ...
The gluteus maximus myocutaneous flap is modified to obviate the necessity of a skin graft to the donor defect. This is a sufficiently large flap which, in the event of a recurrence, can be rerotated. The design and surgical technique of this flap for ischial and sacral pressure sores are described. This ...
OBJECTIVE: The purpose of this perspective is to describe the role of breast MRI in the detection of local tumor recurrence in myocutaneous flap reconstructions and in the evaluation of extent of disease. CONCLUSION: Recognizing the MRI appearance of tumor recurrence in breast myocutaneous flap reconstructions is ...
Necrosis in TRAM (transverse rectus abdominis myocutaneous) still occurs in flap breast reconstruction. Blood flow may be improved by vascular endothelial growth factor (VEGF), an endogenous protein that stimulates neovascularization. Experimental studies of gene therapy with plasmid vector expressing human VEGF (hVEGF) presented ...
Breast reconstruction with transverse rectus abdominis muscle (TRAM) flap raises two contradictory questions: the vascular safety of the flap and the late abdominal wall sequellae. In order to analyse these sequellae, 71 patients with TRAM flap breast reconstruction at the Institut Curie had a late postoperative ...
The deep inferior epigastric artery perforated rectus abdominis (DIEAP-ra) free flap is a modification of the classic myocutaneous DIEA free flap in which only fasciocutaneous tissue is harvested based on the paraumbilical perforators of the medial row. The aim of this retrospective study is to describe our ...
Objective:Cytokines may be a mechanism by which surgical delay can increase flap survival. We previously found that preoperative vascular endothelium growth factor (VEGF) administration in the rat transverse rectus abdominis myocutaneous (TRAM) flap could improve skin paddle survival. In this study, we used partial ...
The transverse rectus abdominis myocutaneous (TRAM) flap can create a good breast shape, however, the patchwork-like scar obviously shows that the breast has been reconstructed. To reconstruct a breast without the patchwork-like appearance, we used a two-stage procedure using a tissue expander before transplanting a de-epithelialised ...
Barraquer-Simons syndrome, a disorder of unknown etiology, is characterized by a cephalothoracic lipodystrophy. We present 2 patients treated with a bilateral free transverse rectus abdominis myocutaneous (TRAM) flap to restore facial contour. Our technique of using a muscle component to fill the cheek defect was based on our ...
Facial defect after an extended total maxillectomy is one of the most difficult deformities to reconstruct aesthetically, because the defect is not only large but also three-dimensional. Although free-flap reconstruction is useful, the patchwork-like scar, bad colour match and poor texture match are major problems. The contracture and displacement of the reconstructed eyelids ...
PURPOSE: The vertical rectus abdominis muscle (VRAM) flap is considered a safe and simple option to cover defects of the trunk and proximal thigh. Detailed long-time follow-up studies in oncologic patients including complications and donor site morbidity are rare. In this study, complications and donor site morbidity were analysed. METHODS: Data of 78 ...
Technical advances in myocutaneous flap preparation have resulted in primary reconstruction now being generally indicated for malignant tumors extensively infiltrating the pelvic cavity and perineum. Pelvic tumor resection can dramatically improve the health-related quality of life (QOL) of patients with locally recurrent rectal cancer complicated by ...
The tumescent technique has been shown to be efficacious in reducing both operative and postoperative bleeding without significant deleterious side effects in suction lipectomy. In this study, the effects of the tumescent technique on postoperative complications in transverse rectus abdominis myocutaneous (TRAM) flap breast ...
Objective:To evaluate the suitability of microvascular flaps for the reconstruction of extensive full-thickness defects of the chest wall.Summary Background Data:Chest wall defects are conventionally reconstructed with pedicular musculocutaneous flaps or the omentum. Sometimes, however, these flaps have already been used, are not ...
The transverse rectus abdominis myocutaneous (TRAM) flap is ideal for postmastectomy reconstruction but is tenuous in morbidly obese patients. Because of their relatively high incidence of postoperative complications, morbidly obese patients are often not considered candidates for autogenous reconstruction. The midabdominal TRAM ...
The objective of the present study was the evaluation of MRI of the breast in the follow-up of patients who had undergone autogenous tissue breast reconstruction using either a latissimus-dorsi muscle flap or a transverse rectus abdominis myocutaneous (TRAM) flap as correlated with patients' clinical, conventional ...
Perioperative blood loss during and following breast reconstruction surgery can have substantial impact on free flap survival and patient morbidity. Transfusion rates of up to 95% have been reported following transverse rectus abdominis myocutaneous flap breast reconstruction, with blood loss described as ...
Involvement of large areas of the mandible or the entire mandible with osteoradionecrosis may result in severe functional disability and cosmetic deformity. The use of a well-vascularized pectoralis major myocutaneous flap from outside the original field of irradiation has been successful in obtaining functional and cosmetic goals. ...
Energy Citations Database
An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is essential in deep inferior epigastric perforator (DIEP) flap reconstruction. We present our experience of using computed tomographic angiography (CTA) of the abdomen as part of our standard preoperative assessment of abdominal-based breast reconstruction. One hundred consecutive cases were ...
This article reports a case of re-elevating a prior vertical rectus abdominis musculocutaneous flap as a deep inferior epigastric artery perforator-based propeller flap to cover a recurrent chest wall defect. This case demonstrates that a conventional musculocutaneous flap tissue with a preserved perforator can be ...
Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and require recruitment of vascularized and massive tissues. The objective of this study was to evaluate the utility of the island myocutaneous flap for the reconstruction of the electrical burn injuries on the cervical region. ...
Early and reliable closure of large meningomyelocoele defects in newborns is critical to prevent severe infectious complications and neurologic deterioration. Here, we introduce a new surgical method for the reconstruction of large horizontal meningomyelocoele defects, in which we use unilateral myocutaneous tissue based on the superior gluteal artery (SGA) as a propellar ...
A 63-year-old female with locally advanced breast cancer was treated with preoperative chemotherapy using docetaxel. The therapeutic regimen was comprised of four cycles at 3-week intervals. One cycle consisted of 80 mg of docetaxel which was administered on day 1. A remarkable response was confirmed. The side effects such as leukopenia, general fatigue and alopecia were moderate and had no ...
Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ...
In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe ...
We present a case of a failed bipedicled (unilateral rectus flap with superior epigastric pedicle preserved and inferior epigastric vessels anastomosed to the thoracodorsal trunk as the second pedicle) transverse rectus abdominis muscle flap that had compromised the dominant pedicle of the latissimus dorsi muscle. A salvage procedure ...
BACKGROUND: Traditional single-stage breast reconstruction with autologous tissue leaves an obvious skin island. Alternatively, a staged reconstruction with the creation of a skin envelope with a tissue expander which is then replaced with a de-epithelialised flap, leaves a breast with the original mastectomy scar and no skin island. METHODS: Consecutive patients who underwent ...
The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM ...
This study describes the use of the bilobed myocutaneous (MC) flap for reconstruction of trunk defect. The authors employ this flap because it offers a greater flexibility in the use of available tissue than many other local conventional flaps, is easy to design, safe to elevate, and causes minimal donor-site ...
Operative treatment of large bladder-vaginal-urethral defects is a problem, especially after radiogenic tissue damage. Successful reconstruction of the defect is only possible when healthy and sufficiently perfused tissue is used. This may be obtained by the interposition of pedicles omentum flap. Contrary to the use of a pedicled myocutaneous gracilis ...
Rupture of the right ventricle may occur because of sternal dehiscence or mediastinitis after cardiac surgery. Direct suture, polytetrafluoroethylene patch, fasciae, and muscle flaps have been used to close a right ventricular rupture. A unique occurrence of repair of a full-thickness right ventricle defect with a de-epithelized myocutaneous ...
The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid ...
Propeller perforator flaps supplied by branches from the transverse cervical artery allow transport of skin from the back region to supraclavicular defects. This article describes a soft tissue defect following resection of melanoma metastasis that was successfully reconstructed using a propeller flap based on a perforator originating from the anterior ...
Ideal reconstruction of the mandible is important for a multitude of reasons and has been and continues to be among the most common surgical challenges for reconstructive surgeons of the head and neck. Historically, pedicle flaps, such as the pectoralis major and deltopectoral myocutaneous flaps, were workhorse ...
Radiation-induced skin changes are commonly seen in patients who have been treated for head and neck malignancies. Some of these skin changes can progress into chronic postradiation ulcers, which despite aggressive medical wound management will not resolve spontaneously. Skin grafts and local cutaneous flaps located within the radiation field are unreliable and rarely provide ...
BACKGROUND: We aimed to present the use of extended lower trapezius myocutaneous flaps in children with scaring and contractures of the face and neck due to burns. METHODS: We retrospectively reviewed the use of 12 extended trapezius myocutaneous flaps in 7 males and 4 females ranging in age from 1.5 to 7�years. ...
PURPOSE: The present clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous flaps for large, full-thickness cheek defect reconstruction after ablative oral cancer surgery. PATIENTS AND METHODS: A retrospective review ...
The vascular effects of isoxsuprine, diazoxide, and isoproterenol were studied in arterial buttock flaps and latissimus dorsi myocutaneous flaps in pigs. Capillary blood flow to the skin and muscles of these flaps was measured by the radioactive microsphere (15-mu diameter) technique 6 hours postoperatively under ...
A modified pectoralis major myocutaneous flap was used to stabilize necrotic neck wounds rapidly in irradiated patients. The flap was a sandwich flap that included an overlying parasternal pectoral skin paddle for pharyngeal reconstruction, the pectoralis muscle for carotid protection, and a meshed skin graft ...
We reconstructed a large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique myocutaneous flap. The patient, a 58-year-old Japanese woman, presented with an inoperable breast carcinoma (Stage IV). Combination chemotherapy with cyclophosphamide (CPA) and epirubicin hydrochloride (EPI) resulted in ...
The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial ...
The development of microsurgical breast reconstruction has resulted in not only the lower abdomen as a source of donor site tissue but also interest in alternative donor sites. These have included perforator-based flaps at the sites of previously described myocutaneous flaps (e.g., superior or inferior gluteal arteries) and the use of ...
The transverse rectus abdominis muscle flap is widely used in free microvascular tissue transfer for breast reconstruction following mastectomy. Flap survival may be compromised by failure at the microsurgical anastomosis due to both venous and arterial thrombosis. It is unclear, whether hereditary thrombophilia represents a risk ...
In 36 patients the first experience of performance of one-stage mammarial glands reconstruction is presented, using tissues of their own after conduction of mastectomy for the mammarial gland cancer. In 27 women patients the transposition or free microvascular transplantation of lower musculocutaneous flap basing on m. Rectus abdominis (transverse rectus ...
We report our experiences in treating chronic radiation injury about the shoulder, a complication of radiation after mastectomy. Left untreated, these can result in chronic infection and/or amputation. The coverage of a large shoulder area presents certain unique problems, which severely limit the usefulness of traditional procedures. We have found that the remarkable size and versatility of the ...
Tracheo-innominate artery fistula (TIF) is an uncommon life-threatening complication of tracheostomy. A prompt diagnosis and surgical intervention can save the life of a TIF patient. Several methods of reconstructing the tracheal defect have been reported, but may not be available in the presence of extensive infection. We used a trough and pectoralis major myocutaneous ...
Urinary tract fistulas resulting from severe trauma or pelvic irradiation are often associated with extensive tissue loss, scar formation, and fibrosis. Two cases, one with a urethro-vaginal fistula secondary to trauma and one with a vesico-vaginal fistula secondary to irradiation, are presented. In neither case could the bladder, urethra, or vagina be repaired primarily. Using a bulbocavernosus ...
Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require ...
An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle ...
Modern surgical treatment of cancer of the hypopharyngo-esophageal cannot be conditioned by the reconstructive procedures. Reconstructive options are based on the size and position of the defect in this important anatomical region. Currently the reconstruction of the hypopharyngo-esophageal tract allows a rapid and suitable restoration of the vital functions, a low morbidity and shortened hospital ...
The platysma myocutaneous flap (PMF) is a common reconstructive option for defects in the head and neck region. Its applications have expanded from the reconstruction of intraoral defects to include laryngo-pharyngeal, lip, and cheek defects. The platysma flap can be superiorly, posteriorly, or inferiorly-based. The superiorly-based ...
BACKGROUND:: We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR). METHODS:: Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three ...
High-voltage electrical burns of the upper extremity are often limb threatening. Typically, emergency fasciotomies are followed by serial debridements until only viable tissue remains. After debridement, flap coverage is required to preserve viable but exposed tendons, nerves, vessels, bones, and joints and to salvage these seriously injured upper extremities. ...
Immediate breast reconstruction has become a standard of care following mastectomy for cancer, largely due to improved esthetic and psychologic outcomes achieved with this technique. However, the current historical standards--transverse rectus abdominis myocutaneous flap reconstruction and expander--implant surgery-still have ...
Objective. To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period. Design. Retrospective review. Setting. University-affiliated hospital. Population. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Methods. Medical records were reviewed. Main outcome measures. ...
Autologous fat grafting has become a common technique for revisional breast surgery. The purpose of this series is to review our experience with fat grafting for the correction of acquired breast deformities. A retrospective review was performed on 107 patients with a history of breast cancer between 1996 and 2010, who had autologous fat grafting at the time of secondary breast reconstruction. The ...
Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial ...
Recurrent poststernotomy mediastinitis has significant morbidity and mortality. Reconstructive treatment begins with pectoral muscle or omental flaps. When these options are unavailable or inadequate, surgeons resort to internal mammary artery-based vertical rectus abdominis muscle flap. If the internal mammary artery is harvested for ...
Oncological Dispensary of Leningrad Region, St.Petersburg Our paper deals with evaluation of the results of using distal pectoralis major myocutaneous flap (38) in 37 patients; bilateral dissection of tissue--1. Plastic reconstruction of surgical effects of the oral cavity and pharynx was performed in 27 (skin cancer--8, parotid salivary gland tumor--1). ...
BACKGROUND.: The extended deep inferior epigastric perforator (DIEP) artery flap had been described in 1983. For head and neck reconstruction, we have been using a variation of this flap, namely a perforator free flap of the deep inferior epigastric system with a superolateral extension of the skin paddle. METHODS.: The purpose of this ...
Breast reconstruction using the lower abdominal free superficial inferior epigastric artery (SIEA) flap has the potential to virtually eliminate abdominal donor-site morbidity because the rectus abdominis fascia and muscle are not incised or excised. However, despite its advantages, the free SIEA flap for breast reconstruction is ...
In the years 1983-1997, 252 female to male transsexuals were treated in the Department of Plastic Surgery of University Medical School in ?�d?. In 209 patients surgical penis construction was performed. The paper presents operative techniques and results of penis construction with the use of four kinds of flaps: a bipedicled abdominal tube flap, a single ...
The objective of the study is to compare the long term outcomes of two common techniques of post-mastectomy breast reconstruction: tissue expansion/breast implants and transverse rectus abdominis musculocutaneous (TRAM) flaps. This four year prospective s...
National Technical Information Service (NTIS)
The goal of reconstruction of the skull base is to repair dural defects with a watertight seal and separate it from the nasopharynx and the exterior environment with well vascularised tissue. This prevents cerebro-spinal fluid leakage and secondary contamination leading to the potentially life threatening complications of meningitis or extradural abscess. Following large composite resections, ...
With improved detection and genetic screening for breast cancer, increasing numbers of patients are choosing mastectomy and immediate breast reconstruction. Advances in breast reconstruction and mastectomy techniques over the last 25 years have increased expectations for breast reconstruction. The purpose of this review is to describe the role of the pedicled transverse rectus ...
We have used a contralateral vertical rectus abdominis musculocutaneous flap based upon the superior epigastric vessels in six patients to provide coverage after resection of locally recurrent breast carcinoma in irradiated tissues. Primary healing of defects as large as 16 cm X 35 cm has been obtained using this technique. Although there is no evidence to ...
A case of a 32-year-old motorcyclist, who sustained an open comminuted fracture of the left tibia and subsequently developed spontaneous cecal perforation following successful fixation of the fracture and reconstruction of the soft tissue defect with a rectus abdominis free flap, is reported. Although benign cecal perforation has been described in patients ...
Prevention of hernia or bulge of the abdominal wall after TRAM breast reconstruction has been a challenge for the reconstruction surgeon. Different techniques have been described to avoid this complication. The use of anterior rectus abdominis sheath (ARAS) for the repair of various abdominal wall hernias has been well described in the literature and is the basis of the ...
The neck, shoulder, and upper trunk serve as donor sites for commonly used flaps in head and neck reconstruction. In order to prevent permanent functional disabilities, a physical therapy program was organized. The anatomy, physiology, and kinesiology of the shoulder muscles that are commonly used in myocutaneous flaps are reviewed. ...
Full thickness chest wall resection and single stage reconstruction for osteoradionecrosis of the chest wall was performed on five patients. All patients had undergone radical mastectomy and radiation therapy from 5 to 18 years prior to chest wall resection. Defects varied from 12 X 5 cm to 15 X 15 cm, and included from two to four ribs. Reconstruction was performed using Marlex mesh to ...
Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rational of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a "new tongue" by the use of this flap. The criteria for these techniques in benign and ...
The treatment of wound complications and deep infection after hemipelvectomy is challenging. We describe a 17-year-old woman with Ewing sarcoma in the pelvis who underwent hemipelvectomy and reconstruction with an artificial hip joint and bone cement. After the operation, skin necrosis and deep infection with methicillin-resistant Staphylococcus aureus (MRSA) were observed. Debridement resulted in ...
The gracilis myo-cutaneous flap was used in 4 patients to cover soft tissue defects of the perineal, scrotal, penile and inguinal regions after Fournier's gangrene. This is a simple technique, which allows a simultaneous reconstruction of the perineoscrotal region. Very satisfactory esthetic and functional results were obtained in the recipient and donor ...
The case of a woman treated for a large rectal cancer with high-dose radiation therapy and abdominoperineal resection followed by a large pelvic abscess is presented. Wound healing, reconstruction, and rehabilitation were achieved with a free latissimus dorsi myocutaneous flap. The importance of providing well-vascularized tissue for wound healing in the ...
Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before ...
In this report, the authors describe the application of a muscle-sparing technique to harvest a myocutaneous latissimus dorsi muscle flap, including only a tiny lateral muscle segment but carrying a large skin paddle, with the advantage of leaving intact innervation and function of the remaining latissimus dorsi muscle. According to the experiences and ...
Pelvic floor reconstruction after pelvic exenteration is challenging, particularly with bacterial contamination and/or pelvic irradiation. Traditional regional myocutaneous flap options are not always avaliable, especially in the multiply operated patient. Human acellular dermal matrix (HADM) confers several advantages and is associated with less morbidity ...
Immediate breast reconstruction is an excellent complementary treatment for patients with ductal carcinoma in situ and early-stage invasive breast cancer. Although lattisimus dorsi myocutaneous flap is one of the well accepted and versatile methods of breast reconstruction, there have been very few reports describing a myoadipose flap, ...
Reconstruction following oncologic resection in the head and neck is complex due to large surgical defects left after removal of skin, subcutaneous, and skeletal structures. It is essential to adequately fill the defect as well as provide an acceptable tissue match in terms of tone, texture, thickness and contour. A 55-year-old male presented with an advanced melanoma in the right pre-tragal area. ...
The closure of a circular defect resulting from excision of large soft-tissue tumours may pose a considerable surgical challenge. We have described a successful result from the use of modified double helix rotation flaps following resection of a fungating 15-cm interscapular basal cell carcinoma. Our technique necessitated a single operation only. Alternatives considered were ...
Large defects of the anterior chest wall lead to gross chest instability that can result in paradoxic respiration. Osteoradionecrosis of the lower sternum and multiple left ribs resulted in a huge, full-thickness defect of the left anterior chest wall in a 67-year-old woman. An iliac osteocutaneous flap (bone segment 3 � 14 cm) was harvested for reconstruction of the bone ...
BACKGROUND:: Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites. PATIENTS AND METHOD:: Between September 2005 and 2009, 11 patients (9 male, 2 female) with ...
Four free-flap types were compared regarding perioperative blood perfusion parameters and to define critical values for success. 166 cases were investigated: radial forearm flap (fasciocutaneous, n=89); fibula flap (osteocutaneous, n=32); ALT flap (myocutaneous, n=25); soleus perforator ...
Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this ...
Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap ...
The feasibility of composite tissue allografts (CTA) has been demonstrated by the successful transplantation of the hand, abdomen and face. However, the survival of these transplants is dependent on immunosupression. Our laboratory is interested in achieving tolerance in order to decrease the risks associated with the use of chronic immunosuppression. The purpose of this experiment was to develop ...
Seven patients with advanced carcinoma of the tongue (T4) were treated with total glossectomy and laryngectomy, neck dissection (radical-functional or radical-traditional) and reconstruction with the pectoralis major myocutaneous flap. The AA. comment the surgical technique, the pros and the cons of the indications, the justification, the objectives and ...
The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or ...
We devised a simple method of chest wall reconstruction in two cases of malignant tumor of the chest. We strained a suture (adsorbable or monofilament) to the intact ribs above and below the defect and fixed the sheets of Marlex mesh in double layers and closed the skin without any myocutaneous flap. The postoperative course was uneventful. This device is ...
The aims of the experiments were to develop and validate a porcine isolated blood perfused myocutaneous flap and tibia model with preserved venous outflow. The stability of the models was tested and washout of microspheres and IDMI was measured. IDMI and ...
The procedure, irradiated mandibular autografts, for primary reconstruction, is presented with an immediate success rate of 88%. Eight cases have undergone primary mandibular reconstruction with the tumorous mandible irradiated to 10,000 rads in a single dose. The longest follow-up is 2 3/4 years. The autograft has proven to be an ideal implant. Major resections of the mandible in conjunction with ...
We present a patient with a rare epithelial-myoepithelial carcinoma of the nasopharynx with a typical biphasic histopathologic pattern. Immunohistochemical findings support the concept that the inner cells differentiate to ductal epithelium and the outer cells to myoepithelium. In this patient complete excision of the tumor and reconstruction with a pedicled sternocleidomastoid ...
Trunk and perineal defects after tumor resection present a challenge to the reconstructive surgeon. When primary closure is not possible, the use of well-vascularized autogenous tissue is required to achieve adequate soft-tissue coverage. Pedicled muscle or myocutaneous flaps provide excellent sources of vascularized tissue for postradiation defects. When ...
Free TRAM flap breast reconstruction was performed in 23 patients from july 1993 through november 1995 at the Saint-Louis Hospital in Paris. The surgical team was composed of eight different surgeons. In all cases a delayed breast reconstruction procedure was performed. All patients in this series had previously received radiation therapy and 82.6% patients presented with ...
Different reconstruction techniques of the anterior and middle skull base as consequence of a defect after surgical treatment of neoplastic pathologies are described in the literature. The aim of the present study is to present our experience regarding the use of microvascular free flaps for reconstruction of the anterior or middle skull base after large defects caused by ...
Although abdominal perforator flaps based on a cutaneous branch of the deep inferior epigastric artery (DIEP flaps) have many advantages, preparing these flaps is technically difficult and requires great skill, especially as the portion of the artery running under the anterior rectus abdominis sheath must be ...
BACKGROUND: Reconstruction of complex urethral defects should provide lasting coverage, a patent tube for voiding, and a natural appearing contour with minimal morbidity to the donor and recipient sites. Many reports have emerged in the literature regarding complex urethral reconstruction through a variety of methods including anterolateral thigh flaps, radial artery forearm ...
PurposeThe pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of ...
We aimed to compare the differences between free flap and pectoralis major myocutaneous flap (PMMF) for reconstruction in oral cavity cancer patients. Patients who received free flap or PMMF reconstruction after ablation surgeries were eligible for the current study. The patients' demographic data, medical history, ...
Extensive posterior chest wall defects, especially those closer to the midline of the trunk, pose surgical challenges in plastic surgery. In these cases, prior to tissue coverage, the status of the pleural cavity and skeletal support need to be addressed to obtain a functional and anatomical reconstruction. We recently operated upon a patient presenting with an aggressive ossifying fibromyxoid ...
Following unilateral iliac artery injection of radiopaque Microfil in cadavers, coronal sections of the anterior abdominal wall at 1-cm intervals were obtained employing computerized axial tomography of the intact specimen as well as xerography of frozen slices. Because they avoid the distortion and disruption of the vasculature induced by anatomical dissection, these studies clearly indicate that ...
Recurrent chronic conditions of the natal cleft, such as pilonidal sinuses, are difficult problems to treat. The deep natal cleft and the rolling effect of one buttock surface over the other contribute to the high recurrence rate. Wide excision of the affected area is the treatment of choice; to cover the defect many techniques have been described that flatten the natal cleft and shift the suture ...
The purpose of this study was to investigate sensory recovery in 33 patients who underwent conventional mastectomy, skin-sparing mastectomy, or nipple-sparing mastectomy with immediate breast reconstruction using abdominal flaps. Reconstructions included a pedicled transverse (28 cases) or vertical (five cases) rectus abdominis musculocutaneous ...
This study reviewed our experience with the gracilis myocutaneous (GMC) flap, potential risk factors for flap necrosis, and long-term morbidity at the donor-site. From 1993 to 2002, 29 GMC flaps were harvested from 27 patients (pedicled n = 21 and free n = 8). The overall incidence of flap ...
Empyema continues to be an uncommon, frustrating, and potentially lethal complication of pneumonectomy. Between 1990 and 1994 we treated 16 cases of recalcitrant postpneumonectomy (partial or total) empyema with combinations of pulse lavage, sharp debridement, muscle flaps, myodermal flaps, and thoracoplasty. We performed 11 pectoralis muscle ...
Postoperative volume changes in reconstructed flaps are known to influence the functional restoration of resected areas of the upper aerodigestive tract. The purposes of this study were to estimate the volume decreases in flaps and investigate clinical factors affecting the volume decrease. The medical records of 19 patients who underwent ablation and ...
Preoperative Doppler ultrasonography for planning free perforator flaps is widely established to identify preoperatively perforators. The method allows one to localise the penetrating point of the perforator through the abdominal fascia. By this means it is not possible to see the intramuscular course or the position of the perforator in relation to the inferior epigastric ...
To determine the best method for preserving abdominal-wall integrity after TRAM flap breast reconstruction, the records of 130 patients followed for at least 6 months (mean 18 months) were examined. Three strategies for management of the abdominal-wall repair were compared. In the first group (72 patients), the entire width of the rectus abdominis muscle ...
The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second ...
To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a ...
PURPOSE: To describe the clinical outcomes of patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy and preoperative radiotherapy, followed by skin-sparing mastectomy (SSM) and immediate autologous breast reconstruction (IABR). METHODS: A retrospective review of 30 LABC patients who underwent SSM and IABR between 1997 to 2007 was performed. Data were drawn from ...
Oropharyngeal tumors are routinely treated with extensive surgical resection and radiotherapy followed by PM and DP myocutaneous flaps performed for reconstruction purposes. The lymph vessels are the main pathways of oropharyngeal tumor dissemination and play an important role in the development of local recurrences and regional tumor invasion. To evaluate ...
INTRODUCTION: Osteosarcoma of the craniofacial bones location is less common, usually with low grade of malignancy; it has better prognosis when surgical excision is complete. REPORT CASE: We report a case of a 35-year-old male diagnosed with a low-grade chondroblastic osteosarcoma of the mandible. The patient was treated with surgery alone and recovered with pectoralis major ...
A technique for covering areas of osteoradionecrosis in the medial aspect of the chest wall has been described. Utilizing a tissue expander, the skin was stretched sufficiently to obtain a suitable length whereby the medial defect could be covered and the donor site closed primarily. Such an operative approach should be considered when the patient presents with a medially located ulcer of small to ...
Ischemia WT aged mice that underwent random myocutaneous flaps and received ISDN ad libitum in the drinking by CD47 Suppression ApoE-null mice 12 to 16 months of age fed a high-fat diet for a minimum of 8 months. Isenberg, Fuminori Hyodo, Loretta K. Pappan, Mones Abu-Asab, Maria Aging on Tissue Responses to Ischemia
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Skull-base surgery is associated with a high risk of cerebrospinal fluid (CSF) leak, infection, and functional and aesthetic deformity. Appropriate reconstruction of cranial-base defects following surgery helps to prevent these complications. Between March 1998 and May 2000, 28 patients (age: 1-68 years) underwent reconstruction of the anterior and middle cranial fossae. The indications for ...
Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local ...
Bilateral prophylactic mastectomy without reconstruction is not accepted by the majority of patients. Successful reconstruction is therefore a mandatory condition for prophylactic mastectomy. Of the many options for autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap best meets requirements for bilateral reconstruction in selected patients. ...
BACKGROUND:: Selective embolization of the inferior epigastric arteries can serve as a method for transverse rectus abdominis musculocutaneous (TRAM) flap delay. The purpose of this study was to determine whether delay by selective arterial embolization is comparable to traditionally surgically delayed TRAM flaps as reported in the ...
The pectoralis major muscle or myocutaneous flap has a nearly 100% success rate in reconstructing chest wall defects. Major adverse sequelae resulting from the use of the pectoralis major muscle or myocutaneous flap are rarely reported in the literature. However, the loss of pectoralis major muscle function caused ...
This article details the experiences of United States military reconstructive surgeons in the soft tissue management of war wounds of the foot and ankle resulting from the conflicts in Iraq and Afghanistan. War wounds from this conflict are commonly caused by blast and fragmentation, and are characteristically extensive, heterogeneous, and severe. Multiple serial d�bridement episodes are ...
This study aimed at evaluating various reconstructive procedures for chest wall radionecrosis after breast carcinoma therapy. Four different techniques were performed between 1973 and 1992 in 120 patients: latissimus dorsi musculocutaneous flap (LDF; n = 81); transposed omentum and split-thickness skin graft (TGO; n = 20); fasciocutaneous flap (FCF; n = ...
BACKGROUND: Purpura fulminans (PF) is a rare syndrome of intravascular thrombosis and haemorrhagic infarction of the skin. The initial symptom of PF is peripheral purpura which progresses to necrosis very rapidly. The prognosis of PF is poor, and the mortality is reported to be around 40%. Even if the patient survives, the patient may require amputation or reconstruction for limbs and facial ...
We evaluated blood flow changes after experimental free tissue transfer and the potential hemodynamic effect of sildenafil on the free flap. Sixteen swine were used for free transfer of a latissimus dorsi myocutaneous flap to the chest that was anastomosed to the internal mammary vessels, and were randomized into controls and study ...
Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of ...
This study compares the outcome of Singapore flap, vertical rectus abdominis musculocutaneous flap (VRAM), and gracilis musculocutaneous flap vaginal reconstruction. A retrospective review of 99 consecutive patients with complete vaginal defects was conducted at the Mayo Clinic from January 1988 to October 2001. ...
Commonly used procedures for reconstructing hypopharyngeal and cervical esophageal defects resulting from total laryngopharyngectomy (TL) are the gastric conduit or colon transposition as well as microvascularized free flaps. Herein we designed an alternative procedure utilizing bilateral platysma myocutaneous flaps (PMCFs) for the ...
The combination of a myocutaneous flap or free cutaneous tissue transfer with a three-dimensional bendable reconstruction plate either of stainless steel or titanium has provided very satisfactory results in primary restoration of mandibular defects following surgical resections in irradiated patients or in those who require postoperative radiotherapy. ...
Severe sacral decubitus ulcers represent a common and often recalcitrant clinical problem in paralyzed or bedridden patients and require treatment strategies ranging from specialty beds and local wound care to aggressive debridement and local or free tissue flap coverage. This article presents the case of a young soldier who sustained severe injuries as a result of an ...
Abdominal wall function is a major concern for plastic surgeons performing breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore, preserves adequate abdominal wall competence. Between January of 1995 and May of ...
The author carried out 50 free flaps in 49 patients during 10 year consulting practice in orthopaedic departments in the regional hospital in Otwock. 43 flaps were transplanted to lower extremities and 7 to upper. Extensive bone defects (bd), requiring reconstruction of shafts especially in case of tibiae predominated. The recipient sites of free tissue ...
This study is designed to evaluate the effect of abdominal quilting sutures on the incidence of abdominal seroma formation in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. It is theorized that the use of such sutures during closure of abdominal flaps will collapse dead space, thus ...
The authors report the successful repair of large lower abdominal hernia defects after transverse rectus abdominis muscle (TRAM) flap breast reconstruction in 11 patients using a technique of intraperitoneal application of synthetic polypropylene (Prolene) mesh anchored to the peritoneal surface of the abdominal wall tissues. Five of these patients had ...
Microvascular free tissue transfer in head and neck reconstruction requires suitable recipient vessels which are frequently compromised by prior surgery or radiotherapy to the neck. This article details a new technique of arterial free flap pedicle anastomosis to the internal carotid artery in a vessel-depleted neck. A 63-year-old female was referred because of recurrence of ...
The relative importance of oxygen in relation to resistance to infection was assessed in 24 mongrel dogs. Rectus abdominis musculocutaneous (MC) and corresponding cutaneous random pattern (RP) flaps based at the level of the xiphoid were elevated, replaced, and sutured. Immediately after the surgical procedure, 0.1 ml saline containing 10(8) Staphylococcus ...
Prelamination is sometimes required for reconstruction of specialized organs. The purpose of this study was to create a chimeric flap model in dogs for prelamination. The anatomy of the deep and superficial caudal epigastric vessels, which supply the rectus abdominis muscle and superficial ventral fascia, respectively, were measured in 14 dogs. Their ...
The goal of the study was to assess whether endothelin-1 levels are increased in tissue and plasma in free flaps. To assess this hypothesis, blood samples were taken from the general circulation before and after reperfusion and from the flap after reperfusion in 20 patients undergoing breast reconstruction with free transverse rectus ...
OBJECTIVE: Patients with and without radiation treatment before their breast reconstruction were compared to study the relationship of radiation to flap-related complications. SUMMARY BACKGROUND DATA: The transverse rectus abdominis muscle (TRAM) flap for breast reconstruction involves a a vascular pedicle and recipient bed, both ...
Surgically delaying a unipedicled lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap has been shown to improve flow within the flap. This delay, however, also affects blood supply and drainage of the entire anterior abdominal wall. The purpose of this study was to compare the abdominal complications between ...
In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of ...
Poland syndrome is characterized by hypoplasia or absence of the breast or nipple, hypoplasia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilages or ribs 2, 3, and 4 or 3, 4, and 5. The chest wall defect is often associated with a lung hernia. Clinical manifestations are extremely ...
A case of radionecrosis of sphenoid and temporal bones is reported. The patient received a combination of surgery, radiotherapy, and chemotherapy for his left maxillary sinus carcinoma. After the combined therapy, necrosis accompanying inflammation developed in the maxillary and temporal regions. Excision of the necrotic tissues was done, and the left ascending ramus of the mandible was resected ...
An experimental study was planned to examine whether the blood supply of muscle would be maintained by reverse flow from the cutaneous arteriolar microcirculatory system via the musculocutaneous perforators. A flap model containing both muscle and skin based on the inferior superficial epigastric vessels was designed with the blood supplied directly from the cutaneous ...
Pectoral major flap is one of most frequently used flaps in head and neck reconstruction. The wide attractiveness of this flap is based on secure vascular stalk made from pectoral branch of thoracoacromial artery. The aim of study was to analyze the variations in vascular supply of pectoral major muscle. The investigation was performed ...
The molecular mechanisms underlying successful myocutaneous skin flap integration, as well as the ischemic loss of transplanted tissue on surgery, remain largely unknown. In this study we used a mouse�model of caudally based skin flaps to determine molecular patterns of acute transplant re-integration. Gene chip-based transcriptional ...
The transversus abdominis plane (TAP) block acts on the nerves localised in the anterior abdominal wall muscles. We evaluated the efficacy on post-bariatric (PB) patients undergoing body-contouring abdominoplasty. We retrospectively evaluated PB patients undergoing abdominoplasty with flank liposuction and compared results to a matched group of TAP aesthetic patients. Outcomes ...
To find an alternative to synthetic mesh closure of abdominal fascial defects after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fascial closure. Dermal grafts have been used for herniorrhaphy and fascial repair after TRAM harvest previously, but have never been ...
Anterior mediastinal tracheostomy (AMT) is a rare but challenging operation associated with a high morbidity and mortality rate mainly related to the invasiveness of the procedure. In order to provide a more conservative technique with a lower risk of major postoperative complications, we proposed: (1) to reduce the extent of chest wall resection to only a trapezoidal segment of the manubrium; (2) ...
To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, ...
Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12-77) underwent radical resection for large (median 10 +/- 5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine ...
Nipple-areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast ...
In the patient with a radiation ulcer of the chest wall, the first question is whether the lesion contains persistent or recurrent cancer. It is also important to determine whether any other local problems such as mediastinal abscess may interfere with the reconstruction. Whether or not cancer is present, all nonviable tissue must be removed. If cancer is not present, and a partial thickness of ...
LEARNING OBJECTIVES:: After reading this article, the participant should be able to: 1. Describe the principles of wound closure, torso reconstruction, and pressure sore reconstruction. 2. Outline standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. 3. Manage and prevent pressure ulcers. SUMMARY:: Chest wall reconstruction is indicated ...
Background:Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort.Methods:The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed.Results:Seven patients, 4 males and 3 females with an average ...
IntroductionPhyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi ...
The perianal skin is a common area for extra-mammary Paget's disease development. The unique clinical, histopathological, and immunohistochemical features which this medical phenomenon demonstrates, along with its rarity and frequent association with synchronous or metachronous carcinomas, present us with a treatment challenge. In order to organize the surgical treatment, it is important to ...
Muscle-sparing perforator free flap breast reconstruction with the use of an inferior epigastric or gluteal perforating artery to create a vascular pedicle is increasingly popular because it obviates breast implants and results in lower donor site morbidity than breast reconstruction with myocutaneous flaps. The tissue harvesting ...
Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. Classification: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with ...
Cantrell syndrome is a very rare congenital anomaly with up to five features: a midline, upper abdominal wall abnormality, lower sternal defect, anterior diaphragmatic defect, diaphragmatic pericardial defect, and congenital abnormalities of the heart. This report describes our experience of performing a reconstruction of a chest wall defect in a Cantrell syndrome case with herniation of the ...
The infusion pain pump has been a valuable addition to postoperative pain management in plastic and reconstructive surgery. Concerns have been raised regarding the potential ischemic or infectious complications of placing a catheter beneath the operative site for infusion of local anesthesia (+/- epinephrine). The purpose of this review is to document our experience with this form of postoperative ...
Orbital exenteration is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin. This operation is reserved for the treatment of potentially life-threatening malignancies arising from the orbit, paranasal sinuses or periocular skin. The marked increase in the ...
SummaryOrbital exenteration is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin. This operation is reserved for the treatment of potentially life-threatening malignancies arising from the orbit, paranasal sinuses or periocular skin. The marked increase in ...
Conclusions: Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery. Objective: To ...
The most difficult aspect of the surgical treatment of chest wall tumors is reconstruction of the large residual defect. Materials that have been used include Marlex, Goretex, Vicryl, bone, metal, and fascia. The authors' successful experience with dehydrated human dura (Tutoplast) for moderate-size defects is described. A large Askin's tumor in a 13-year-old boy required resection of the right ...
Chest wall tumors have long represented challenging clinical entities for surgeons. Until recently, incorrect diagnosis, incomplete resection, or inability to perform successful reconstruction of large thoracic wall defects led to high rates of perioperative morbidity and mortality. The latter were primarily associated with infections of the pleural cavity, respiratory failure, and paradoxical ...
We present the successful reconstruction of a large mandibular defect with a severe maxillofacial deformity after malignant tumor resection and irradiation. The patient was a 16-year-old boy with a defect in the left mandible, which extended from the mandibular body to the condylar process and hypoplasia of the maxillozygomatic complex on the left side as a result of ablation and radiotherapy of a ...
